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Annals of Surgical Oncology

, Volume 25, Issue 9, pp 2563–2572 | Cite as

Treatment Intensity Differences After Early-Stage Breast Cancer (ESBC) Diagnosis Depending on Participation in a Screening Program

  • Kenneth Elder
  • Carolyn Nickson
  • Melinda Pattanasri
  • Samuel Cooke
  • Dorothy Machalek
  • Allison Rose
  • Arlene Mou
  • John Paxton Collins
  • Allan Park
  • Richard De Boer
  • Claire Phillips
  • Vicki Pridmore
  • Helen Farrugia
  • G. Bruce MannEmail author
Breast Oncology

Abstract

Background

While population mammographic screening identifies early-stage breast cancers (ESBCs; ductal carcinoma in situ [DCIS] and invasive disease stages 1–3A), commentaries suggest that harms from overdiagnosis and overtreatment may outweigh the benefits. Apparent benefits to patients with screen-detected cancers may be due to selection bias from exclusion of interval cancers (ICs). Treatment intensity is rarely discussed, with an assumption that all ESBCs are treated similarly. We hypothesized that women diagnosed while in a screening program would receive less-intense treatment than those never or not recently screened (NRS).

Methods

This was a retrospective analysis of all women aged 50–69 years managed for ESBC (invasive or DCIS) during the period 2007–2013 within a single service, comparing treatment according to screening status. Data on demographics, detection, pathology, and treatment were derived from hospital, cancer registry, and screening service records.

Results

Overall, 622 patients were active screeners (AS) at diagnosis (569 screen-detected and 53 ICs) and 169 patients were NRS. AS cancers were smaller (17 mm vs. 26 mm, p < 0.0001), less likely to involve nodes (26% vs. 48%, p < 0.0001), and lower grade. For invasive cancer, NRS patients were more likely to be recommended for mastectomies [35% vs. 16%; risk ratio(RR) 2.2, p < 0.0001], axillary dissection (43% vs. 19%; RR 2.3, p < 0.0001), adjuvant chemotherapy (65% vs. 37%; RR 1.7, p < 0.0001), and postmastectomy radiotherapy (58% vs. 39%; RR 1.5, p = 0.04).

Conclusion

Participants in population screening diagnosed with ESBC receive substantially less-intense treatment than non-participants. Differences persist when potential overdiagnosis is taken into account; these differences should be factored into debates around mammographic screening.

Notes

Acknowledgment

None.

Author Contributions

KE: Literature search, study design, management, data collection, analysis and interpretation, writing, manuscript preparation and review, and approval of the final version of the manuscript. CN: Study design, management, data collection, analysis and interpretation, writing, manuscript preparation and review, and approval of the final version of the manuscript. MP: Data collection and analysis, and approval of the final version of the manuscript. SC: Literature search, study design and data collection, and approval of the final version of the manuscript. DM: Data management, review of manuscript, and approval of the final version of the manuscript. AR: Data analysis and interpretation of analysis, review of manuscript, and approval of the final version of the manuscript. AM: Data analysis and interpretation of analysis, review of the manuscript, and approval of the final version of the manuscript. JPC: Retrospective MDM recommendations, data analysis, review of the manuscript, and approval of the final version of the manuscript. AP: Data collection, and approval of final version of the manuscript. RB: Retrospective MDM recommendations, data analysis, review of manuscript, and approval of the final version of the manuscript. CP: Retrospective MDM recommendations, data analysis, and approval of the final version of the manuscript. VP: Data collection and review of the manuscript, and approval of the final version of the manuscript. HF: Data collection and interpretation of analysis, review of the manuscript, and approval of the final version of the manuscript. GBM: Concept development, study design, data collection, analysis and interpretation, retrospective MDM recommendations, manuscript preparation and review, writing, and approval of the final version of the manuscript.

Funding

This project is partly funded through the Cancer Australia Priority-driven Collaborative Cancer Research Scheme (Nickson C, Canfell K, Barandregt J, Petrie D, Mann B, Brennan P. Maximising benefits and minimising harms in the BreastScreen program: a population health economics modelling approach. 2014–2016) and by research funds of the Royal Melbourne Hospital/Royal Women’s Hospital Breast Service.

Disclosure

No conflict of interests declared.

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Kenneth Elder
    • 1
  • Carolyn Nickson
    • 2
    • 6
  • Melinda Pattanasri
    • 1
  • Samuel Cooke
    • 1
  • Dorothy Machalek
    • 2
  • Allison Rose
    • 1
  • Arlene Mou
    • 1
  • John Paxton Collins
    • 1
    • 3
  • Allan Park
    • 1
  • Richard De Boer
    • 1
  • Claire Phillips
    • 1
  • Vicki Pridmore
    • 4
  • Helen Farrugia
    • 5
  • G. Bruce Mann
    • 1
    • 3
    Email author
  1. 1.The Breast ServiceRoyal Melbourne and Royal Women’s HospitalParkvilleAustralia
  2. 2.Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneParkvilleAustralia
  3. 3.Department of SurgeryThe University of MelbourneParkvilleAustralia
  4. 4.BreastScreen VictoriaCarltonAustralia
  5. 5.Victorian Cancer RegistryMelbourneAustralia
  6. 6.Cancer Council New South WalesWoolloomoolooAustralia

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