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Trends in surgical treatment for breast cancer in Germany after the implementation of the mammography screening program

European Journal of Epidemiology volume 34, pages 1143–1150 (2019)Cite this article

Abstract

In Germany, the nationwide population-based mammography screening program (MSP) was introduced in 2005 and is full-running since 2010. By 2014, incidence rates for invasive breast cancer were very similar to those of the pre-screening era. Therefore, the ongoing effect of the MSP on breast cancer surgery rates can now be investigated. We analyzed population-based breast-conserving (BCS) and mastectomy (MET) surgery rates (per 100,000) among women aged < 50, 50–69 (eligible for the MSP), and 70+ years among women with in situ and invasive breast cancer during 2005–2015. For invasive breast cancer, both BCS and MET rates slightly increased in the age group < 50 years (38.3 in 2005 vs 42.5 in 2015 and 15.7 vs 18.2, respectively). In contrast, MET rates considerably decreased among women aged 50–69 and 70+ years (92 vs 65.4 and 155.4 vs 122.1, respectively), while BCS rates increased in both age groups (210.6 vs 254.4 and 147.2 vs 187, respectively). For in situ breast cancer, MET rates slightly increased in all age groups. BCS rates slightly increased in women aged < 50, but nearly doubled for women aged 50–69 (26.9 vs 49.1) and markedly increased in the 70+ age group (11.5 vs 16.1). During and after the implementation of MSP, there was a strong shift towards BCS within the screening-eligible age group and for women aged 70+ . Women with invasive breast cancer in these age groups may profit from screening with a decline of MET rates in favor of BCS rates at the expense of higher surgery rates for in situ breast cancer.

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Acknowledgements

This study was funded by German Cancer Aid (Deutsche Krebshilfe) [Grant No. 70112088]. The funding source had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the paper for publication.

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Affiliations

  1. Center of Clinical Epidemiology, c/o Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany

    Pietro Trocchi & Andreas Stang

  2. Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Auf’m Hennekamp 65, 40225, Düsseldorf, Germany

    Oliver Kuss

  3. Institute of Medical Statistics, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40227, Düsseldorf, Germany

    Oliver Kuss

  4. Kooperationsgemeinschaft Mammographie, Goethestr. 85, 10623, Berlin, Germany

    Vanessa Kääb-Sanyal

  5. Cancer Registry North Rhine-Westphalia, Gesundheitscampus 10, 44801, Bochum, Germany

    Oliver Heidinger

  6. Department of Epidemiology, School of Public Health, Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA

    Andreas Stang

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  1. Pietro Trocchi
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  2. Oliver Kuss
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  3. Vanessa Kääb-Sanyal
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  4. Oliver Heidinger
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  5. Andreas Stang
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Correspondence to Andreas Stang.

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Trocchi, P., Kuss, O., Kääb-Sanyal, V. et al. Trends in surgical treatment for breast cancer in Germany after the implementation of the mammography screening program. Eur J Epidemiol 34, 1143–1150 (2019). https://doi.org/10.1007/s10654-019-00570-x

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  • DOI: https://doi.org/10.1007/s10654-019-00570-x

Keywords

  • Breast neoplasms
  • Mastectomy
  • Breast-conserving surgery
  • Germany
  • Mammography
  • Screening