Evaluating Organized Breast Cancer Screening Implementation
Open Access
- 1 February 2004
- journal article
- research article
- Published by American Association for Cancer Research (AACR) in Cancer Epidemiology, Biomarkers & Prevention
- Vol. 13 (2), 225-234
- https://doi.org/10.1158/1055-9965.epi-03-0206
Abstract
The objective of our study was to evaluate organized breast cancer screening implementation by measuring the association between screening program enrollment and late-stage disease. Our setting was a health plan using mailed mammography reminders to women ages ≥40. We conducted yearly cross-sectional summaries of mammography experience and late-stage (regional or distant Surveillance Epidemiology and End Results Reporting (SEER) stage) breast cancer occurrence for all of the health-plan women ages ≥40 (1986–1998). We estimated the odds of late-stage breast cancer among health-plan and surrounding community women because it was too early to compare changes in mortality. We also estimated the odds of late-stage disease (1995–1998) associated with program enrollment and mammography screening among health-plan women. We found that mammography-within-two-years increased within the health plan from 25.9% to 51.2% among women ages 40–49 and from 32.9% to 74.7% among women ages ≥50. Health-plan late-stage rates were lower than those in the surrounding community [ages 40–49: odds ratio (OR), 0.87; 95% confidence interval (CI), 0.77–0.99; ages 50–79: OR, 0.86; 95% CI, 0.80–0.92] and declined parallel to the community. Among health-plan cancer cases, women ages ≥43 who were enrolled in the screening program and who had at least one program mammogram were less likely to have late-stage disease compared with the women not enrolled in the program (OR, 0.31; 95% CI, 0.16–0.61) but the odds of late-stage was also reduced among program-enrolled women not receiving program mammograms (OR, 0.45; 95% CI, 0.21–0.95). We concluded that enrollment in organized screening is associated with increased likelihood of mammography and reduced odds of late-stage breast cancer. Addressing the concerns of un-enrolled women and those without mammograms offers an opportunity for further late-stage disease reduction.Keywords
This publication has 27 references indexed in Scilit:
- Routine mammography is associated with earlier stage disease and greater eligibility for breast conservation in breast carcinoma patients age 40 years and olderCancer, 2003
- The impact of organized mammography service screening on breast carcinoma mortality in seven Swedish countiesCancer, 2002
- The Mammography ControversyThe Oncologist, 2002
- Quality assurance for screening mammography: an international comparisonJournal of Epidemiology and Community Health, 2001
- The Role of Physician Recommendation in Women's Mammography UseMedical Care, 2000
- Breast cancer screening in 21 countriesEuropean Journal Of Cancer Prevention, 1999
- Nation‐wide breast cancer screening in the Netherlands: Support for breast‐cancer mortality reductionInternational Journal of Cancer, 1995
- Promoting Screening Mammography in Inner-City Settings: A Randomized Controlled Trial of Computerized Reminders as a Component of a Program to Facilitate MammographyMedical Care, 1994
- Quantitative approaches to the evaluation of screening programsWorld Journal of Surgery, 1989
- A clinically effective breast cancer screening program can be cost-effective, tooPreventive Medicine, 1987