Skip to main content

Effect of mammography screening on surgical treatment for breast cancer: a nationwide analysis of hospitalization rates in Germany 2005–2009

Abstract

The aim of this study was to assess the association between the introduction of the nationwide mammography screening program (MSP) and breast cancer surgery rates in Germany 2005–2009. We used nationwide DRG hospitalization files (2005–2009) and analyzed surgery rates for the treatment of invasive and in situ breast cancer in Germany. We used actual numbers of screened women to model the influence of the introduction of the MSP on surgery rates. During 2005 through 2009, the rate of breast-conserving surgery for invasive and in situ breast cancer increased among all age groups. However, rate increases for invasive and in situ breast surgery were largest among women aged 50–69 years (invasive: rate difference [per 100,000] 95.1, 95 % CI 90.7; 99.5; in situ: rate difference 34.4, 95 % CI 32.6; 36.2). Mastectomy rates generally showed little change over time. Conditional on a 70 % participation in the MSP, our model predicts that the estimated increase of mastectomy rates for invasive and in situ breast cancer among women aged 50–69 years during the introductory phase of the MSP would be 4.2 (95 % CI −0.2; 8.6) and 6.1 per 100,000 (95 % CI 5.0; 7.1), respectively. The introduction of the nationwide MSP shows markedly rising rates of breast conserving surgery for women aged 50–69 years with invasive and in situ breast cancer. This increase is expected as a consequence of the first screening round. The model-based estimate for the increase of mastectomy rates, assuming a 70 % MSP participation, is lower than the reported increases observed in MSP in other countries.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. Atlas der Krebsinzidenz und Krebsmortalität. 2012.

  2. Bundesministerium für Gesundheit und Soziale Sicherung. Bekanntmachung des Bundesausschusses der Ärzte und Krankenkassen über eine Änderung der Richtlinien über die Früherkennung von Krebserkrankungen. Bundesanzeiger. 2004;1:2.

    Google Scholar 

  3. European guidelines for quality assurance in breast cancer screening and diagnosis. Luxembourg: Office for Official Publications of the European Communities, 2006.

  4. Vainio H, Banchini F. Breast cancer screening. Lyon: IARC press; 2002.

    Google Scholar 

  5. Sudmann A, Skarre E, Talleraas O, Norstein J. Breast-Conserving Surgery and Sentinel Node Procedure in Norway, 1993–2001. Tidsskr Nor Laegeforen. 2005;125(5):556–9.

    PubMed  Google Scholar 

  6. Ernst MF, Voogd AC, Coebergh JW, Coebergh JW, Coebergh JW, Repelaer van Drie OJ, Roukema JA. The Introduction of Mammographical screening has had little effect on the trend in breast-conserving surgery: a population-based study in Southeast Netherlands. Eur J Cancer. 2001;37(18):2435–40.

    PubMed  Article  CAS  Google Scholar 

  7. Suhrke P, Maehlen J, Schlichting E, Jorgensen KJ, Gotzsche PC, Zahl PH. Effect of mammography screening on surgical treatment for breast cancer in Norway: comparative analysis of cancer registry data. BMJ. 2011;343:d4692.

    PubMed  Article  Google Scholar 

  8. Freedman GM, Anderson PR, Goldstein LJ, Hanlon AL, Cianfrocca ME, Millenson MM, von Mehren M, Torosian MH, Boraas MC, Nicolaou N, Patchefsky AS, Evers K. Routine mammography is associated with earlier stage disease and greater eligibility for breast conservation in breast Carcinoma patients age 40 years and older. Cancer. 2003;98(5):918–25.

    PubMed  Article  Google Scholar 

  9. Coldman AJ, Phillips N, Speers C. A retrospective study of the effect of participation in screening mammography on the use of chemotherapy and breast conserving surgery. Int J Cancer. 2007;120(10):2185–90.

    PubMed  Article  CAS  Google Scholar 

  10. ICD-10-GM 2005 Systematisches Verzeichnis: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision—German Modification. Köln: Deutscher Ärzteverlag, 2004.

  11. ICD-10-GM 2006 Systematisches Verzeichnis: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme. Köln: Deutscher Ärzteverlag, 2006.

  12. ICD-10-GM 2007 Systematisches Verzeichnis: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme. Köln: Deutscher Ärzteverlag, 2006.

  13. ICD-10-GM 2008 Systematisches Verzeichnis: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme. Köln: Deutscher Ärzteverlag, 2007.

  14. ICD-10-GM 2009 Systematisches Verzeichnis: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme. Köln: Deutscher Ärzteverlag, 2008.

  15. OPS 2005 Systematisches Verzeichnis. Köln: Deutscher Ärzteverlag, 2005.

  16. OPS 2006 Systematisches Verzeichnis. Köln: Deutscher Ärzteverlag, 2006.

  17. OPS 2007 Systematisches Verzeichnis. Köln: Deutscher Ärzteverlag, 2007.

  18. OPS 2008 Systematisches Verzeichnis. Köln: Deutscher Ärzteverlag, 2008.

  19. OPS 2009 Systematisches Verzeichnis. Köln: Deutscher Ärzteverlag, 2009.

  20. Stang A, Katalinic A, Dieckmann KP, Pritzkuleit R, Stabenow R. A novel approach to estimate the German-wide incidence of testicular cancer. Cancer Epidemiol. 2010;34:13–9.

    PubMed  Article  Google Scholar 

  21. Stang A, Weichenthal M. Micrographic surgery of skin cancer in German Hospitals 2005–2006. J Eur Acad Dermatol Venereol. 2011;25:422–8.

    PubMed  Article  CAS  Google Scholar 

  22. Stang A, Merrill RM, Kuss O. Nationwide rates of conversion from laparoscopic or vaginal hysterectomy to open abdominal hysterectomy in Germany. Eur J Epidemiol. 2011;26:125–33.

    PubMed  Article  Google Scholar 

  23. Stang A, Merrill RM, Kuss O. Hysterectomy in Germany: a DRG-based nationwide analysis, 2005–2006. Dtsch Arztebl Int. 2011;108(30):508–14.

    PubMed  Google Scholar 

  24. Stang A, Merrill RM, Kuss O. Prevalence-corrected hysterectomy rates by age and indication in Germany 2005–2006. Arch Gynecol Obstet. 2012;286(5):1193–200.

    PubMed  Article  Google Scholar 

  25. Kooperationsgemeinschaft Mammographie. Evaluationsbericht 2005–2007. Ergebnisse des Mammographie-Screening-Programms in Deutschland. 1–121. 2009. Köln, Kooperationsgemeinschaft Mammographie.

  26. Kooperationsgemeinschaft Mammographie. Evaluationsbericht 2008–2009. Ergebnisse des Mammographie-Screening-Programms in Deutschland. 1–175. 2012. Berlin, Kooperationsgemeinschaft Mammographie.

  27. Boshuizen HC, Feskens EJ. Fitting additive poisson models. Epidemiol Perspect Innov. 2010;7:4.

    PubMed  Article  Google Scholar 

  28. Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA. 2009;302(15):1685–92.

    PubMed  Article  CAS  Google Scholar 

  29. Paci E, Duffy SW, Giorgi D, Zappa M, Crocetti E, Vezzosi V, Bianchi S, Cataliotti L, del Turco MR. Are breast cancer screening programmes increasing rates of mastectomy? Observational study. BMJ. 2002;325(7361):418.

    PubMed  Article  Google Scholar 

  30. Vaidya JS, Moore RH, Hall R, Spence D, Gotzsche PC, Baum M, Thornton H. Rapid Response to: Paci E, Duffy SW, Giorgi D et al. Are breast cancer screening programmes increasing rates of mastectomy? Observational study. 31-8-2012.

  31. Zorzi M, Puliti D, Vettorazzi M, De Lisi V, Falcini F, Federico M, Ferretti S, Moffa IF, Mangone L, Mano MP, Naldoni C, Ponti A, Traina A, Tumino R, Paci E. Mastectomy rates are decreasing in the era of service screening: a population-based study in Italy (1997–2001). Br J Cancer. 2006;95(9):1265–8.

    PubMed  Article  CAS  Google Scholar 

  32. Gotzsche PC. Trends in Breast-Conserving Surgery in the Southeast Netherlands: Comments on Article by Ernst and Colleagues. Eur J Cancer 2001, 37, 2435–2440. Eur J Cancer 2002; 38(9): 1288–1290.

    Google Scholar 

  33. Walsh PM, McCarron P, Middleton RJ, Comber H, Gavin AT, Murray L. Influence of mammographic screening on trends in breast-conserving surgery in Ireland. Eur J Cancer Prev. 2006;15(2):138–48.

    PubMed  Article  Google Scholar 

  34. Douek M, Baum M. Mass breast screening: Is there a hidden cost? Br J Surg. 2003;90(Suppl. 1):44.

    Google Scholar 

  35. Schubert-Fritschle G, Hölscher G, Schmidt M, Eckel R, Engel J, Tretter W, Hölzel D. Jahresbericht 2001/2002 des klinisch-epidemiologischen Krebsregisters am Tumorzentrum München. München: W. Zuckschwerdt Verlag; 2004.

    Google Scholar 

  36. Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms. Germering: W. Zuckschwerdt Verlag GmbH; 2012.

  37. Giersiepen K, Haartje U, Hentschel S, Katalinic A, Kieschke J. Brustkrebsregistrierung in Deutschland: Tumorstadienverteilung in der Zielgruppe für das Mammographie-Screening. Dtsch Arztebl. 2004;101(30):A2117–22.

    Google Scholar 

Download references

Acknowledgments

This study was not funded.

Conflict of interest

None of the authors declares any conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andreas Stang.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 11 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Stang, A., Kääb-Sanyal, V., Hense, HW. et al. Effect of mammography screening on surgical treatment for breast cancer: a nationwide analysis of hospitalization rates in Germany 2005–2009. Eur J Epidemiol 28, 689–696 (2013). https://doi.org/10.1007/s10654-013-9816-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-013-9816-9

Keywords

  • Breast neoplasms
  • Early cancer detection
  • Mastectomy
  • Breast-conserving surgery
  • Germany