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Interval cancers in the Dutch breast cancer screening programme
J Fracheboud1, H J de Koning, P M Beemsterboer
1Department of Public Health, Erasmus University Rotterdam, The Netherlands.
British Journal of Cancer
|November 11, 1999
Summary
The Dutch breast cancer screening program identified interval cancers, which are cancers detected between screenings. While generally smaller, these cancers suggest a need to improve early detection methods and reduce false negatives.
Area of Science:
- Oncology
- Public Health
- Radiology
Background:
- The Netherlands implemented a nationwide breast cancer screening program for women aged 50-69 in 1989.
- Interval cancers, diagnosed between scheduled screenings, are a key metric for evaluating screening program effectiveness.
Purpose of the Study:
- To assess the incidence and stage distribution of interval breast cancers in women participating in the Dutch screening program (1990-1993).
- To compare findings with data from UK screening programs in North West and East Anglia.
Main Methods:
- Analysis of 0.84 million screened women's records linked to regional cancer registries for a minimum 2.5-year follow-up.
- Calculation of age-adjusted incidence rates and relative incidences by tumor size for screen-detected, interval, and non-screened cancers.
- Comparison of Dutch data with published UK data.
Main Results:
- 1527 interval cancers were identified, with incidence rates of 0.95 and 0.99 per 1000 woman-years post-initial and subsequent screens, respectively.
- Interval cancers represented 27-52% of underlying incidence in the first and second years after screening.
- Interval cancers generally showed a more favorable tumor size distribution than cancers in non-screened women.
Conclusions:
- The Dutch program detected fewer favorable invasive cancers during initial screens compared to the UK, but interval cancer numbers align with UK findings.
- Consideration of measures to enhance detection of small invasive cancers and reduce false-negative rates is recommended, even with potential increases in referral rates.