1
|
Lundberg FE, Kroman N, Lambe M, Andersson TML, Engholm G, Johannesen TB, Virtanen A, Pettersson D, Ólafsdóttir EJ, Birgisson H, Lambert PC, Mørch LS, Johansson ALV. Age-specific survival trends and life-years lost in women with breast cancer 1990-2016: the NORDCAN survival studies. Acta Oncol 2022; 61:1481-1489. [PMID: 36542678 DOI: 10.1080/0284186x.2022.2156811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND A recent overview of cancer survival trends 1990-2016 in the Nordic countries reported continued improvements in age-standardized breast cancer survival among women. The aim was to estimate age-specific survival trends over calendar time, including life-years lost, to evaluate if improvements have benefited patients across all ages in the Nordic countries. METHODS Data on breast cancers diagnosed 1990-2016 in Denmark, Finland, Iceland, Norway, and Sweden were obtained from the NORDCAN database. Age-standardized and age-specific relative survival (RS) was estimated using flexible parametric models, as was reference-adjusted crude probabilities of death and life-years lost. RESULTS Age-standardized period estimates of 5-year RS in women diagnosed with breast cancer ranged from 87% to 90% and 10-year RS from 74% to 85%. Ten-year RS increased with 15-18 percentage points from 1990 to 2016, except in Sweden (+9 percentage points) which had the highest survival in 1990. The largest improvements were observed in Denmark, where a previous survival disadvantage diminished. Most recent 5-year crude probabilities of cancer death ranged from 9% (Finland, Sweden) to 12% (Denmark, Iceland), and life-years lost from 3.3 years (Finland) to 4.6 years (Denmark). Although survival improvements were consistent across different ages, women aged ≥70 years had the lowest RS in all countries. Period estimates of 5-year RS were 94-95% in age 55 years and 84-89% in age 75 years, while 10-year RS were 88-91% in age 55 years and 69-84% in age 75 years. Women aged 40 years lost on average 11.0-13.8 years, while women lost 3.8-6.0 years if aged 55 and 1.9-3.5 years if aged 75 years. CONCLUSIONS Survival for Nordic women with breast cancer improved from 1990 to 2016 in all age groups, albeit with larger country variation among older women where survival was also lower. Women over 70 years of age have not had the same survival improvement as women of younger age.
Collapse
Affiliation(s)
- Frida E Lundberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Niels Kroman
- Department Breast Surgery, Copenhagen University Hospital (Herlev/Gentofte), Copenhagen, Denmark
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Regional Cancer Centre Uppsala Örebro, Uppsala, Sweden
| | - Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Gerda Engholm
- Danish Cancer Society, Cancer Surveillance and Pharmacoepidemiology, Copenhagen, Denmark
| | | | - Anni Virtanen
- Finnish Cancer Registry, Helsinki, Finland.,Department of Pathology, University of Helsinki, and HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - David Pettersson
- Swedish Cancer Registry, National Board of Health and Welfare, Stockholm, Sweden
| | | | | | - Paul C Lambert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lina Steinrud Mørch
- Danish Cancer Society, Cancer Surveillance and Pharmacoepidemiology, Copenhagen, Denmark
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Cancer Registry of Norway, Oslo, Norway
| |
Collapse
|
2
|
Vale DB, Anttila A, Ponti A, Senore C, Sankaranaryanan R, Ronco G, Segnan N, Tomatis M, Žakelj MP, Elfström KM, Lönnberg S, Dillner J, Basu P. Response to the author: invitation to cancer screening: putting the car before the horse? Eur J Cancer Prev 2019; 28:458-459. [PMID: 31385844 DOI: 10.1097/cej.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diama B Vale
- Departamento de Tocoginecologia, Divisão de Oncologia, Universidade Estadual de Campinas, Brazil
| | | | - Antonio Ponti
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Carlo Senore
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | | | - Guglielmo Ronco
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Nereo Segnan
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Mariano Tomatis
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Maja P Žakelj
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Stefan Lönnberg
- Cancer Registry of Norway, Oslo, Norway, Finnish Cancer Registry, Helsinki, Finland
| | | | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
3
|
Beau AB, Andersen PK, Vejborg I, Lynge E. Limitations in the Effect of Screening on Breast Cancer Mortality. J Clin Oncol 2018; 36:2988-2994. [PMID: 30179570 PMCID: PMC6324089 DOI: 10.1200/jco.2018.78.0270] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Randomized, controlled trials showed that screening reduces breast cancer
mortality rates, but some recent observational studies have concluded that
programmatic screening has had minor effect on breast cancer mortality
rates. This apparent contradiction might be explained by the use of
aggregated data in observational studies. We assessed the long-term effect
of screening using individual-level data. Materials and Methods Using data from mammography screening in the Copenhagen and Danish national
registers, we compared the observed breast cancer mortality rate in women
invited to screening with the expected rate in absence of screening. The
effect was examined using the “naïve model,” which
included all breast cancer deaths; the “follow-up model,”
which counted only breast cancer deaths in women diagnosed after their first
invitation to screening; and the “evaluation model,” which is
similar to the follow-up model during screening age, but after screening
age, which counted only breast cancer deaths and person-years in women
diagnosed during screening age. Results We included 18,781,292 person-years, 976,743 of which were from women invited
to screening. The naïve and follow-up models showed, respectively,
10% and 11% reduction in breast cancer mortality after invitation to
screening. However, many breast cancer deaths occurred in women whose cancer
was diagnosed when they were no longer eligible for screening. Accounting
for this dilution, the evaluation model showed a 20% (95% CI, 10% to 29%)
reduction in breast cancer mortality after invitation to screening. Conclusion Screening had a clear long-term beneficial effect with a 20% reduction in
breast cancer–associated mortality in the invited population.
However, this effect was, by nature, restricted to breast cancer deaths in
women who could potentially benefit from screening. Our study highlights the
complexity in evaluating the long-term effect of breast cancer screening
from observational data.
Collapse
Affiliation(s)
- Anna-Belle Beau
- Anna-Belle Beau, Per Kragh Andersen, and Elsebeth Lynge, University of Copenhagen; Ilse Vejborg, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Per Kragh Andersen
- Anna-Belle Beau, Per Kragh Andersen, and Elsebeth Lynge, University of Copenhagen; Ilse Vejborg, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ilse Vejborg
- Anna-Belle Beau, Per Kragh Andersen, and Elsebeth Lynge, University of Copenhagen; Ilse Vejborg, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elsebeth Lynge
- Anna-Belle Beau, Per Kragh Andersen, and Elsebeth Lynge, University of Copenhagen; Ilse Vejborg, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
4
|
Sivaram S, Majumdar G, Perin D, Nessa A, Broeders M, Lynge E, Saraiya M, Segnan N, Sankaranarayanan R, Rajaraman P, Trimble E, Taplin S, Rath GK, Mehrotra R. Population-based cancer screening programmes in low-income and middle-income countries: regional consultation of the International Cancer Screening Network in India. Lancet Oncol 2018; 19:e113-e122. [PMID: 29413465 PMCID: PMC5835355 DOI: 10.1016/s1470-2045(18)30003-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/17/2017] [Accepted: 11/16/2017] [Indexed: 12/16/2022]
Abstract
The reductions in cancer morbidity and mortality afforded by population-based cancer screening programmes have led many low-income and middle-income countries to consider the implementation of national screening programmes in the public sector. Screening at the population level, when planned and organised, can greatly benefit the population, whilst disorganised screening can increase costs and reduce benefits. The International Cancer Screening Network (ICSN) was created to share lessons, experience, and evidence regarding cancer screening in countries with organised screening programmes. Organised screening programmes provide screening to an identifiable target population and use multidisciplinary delivery teams, coordinated clinical oversight committees, and regular review by a multidisciplinary evaluation board to maximise benefit to the target population. In this Series paper, we report outcomes of the first regional consultation of the ICSN held in Agartala, India (Sept 5-7, 2016), which included discussions from cancer screening programmes from Denmark, the Netherlands, USA, and Bangladesh. We outline six essential elements of population-based cancer screening programmes, and share recommendations from the meeting that policy makers might want to consider before implementation.
Collapse
Affiliation(s)
- Sudha Sivaram
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | - Douglas Perin
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - Ashrafun Nessa
- Department of Obstetrics and Gynecology, Bangabandhu Sheikh, Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Mireille Broeders
- Department for Health Evidence, Radboudumc, and Dutch Expert Centre for Screening, Nijmegen, Netherlands
| | - Elsebeth Lynge
- Center of Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - Mona Saraiya
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nereo Segnan
- Center for Epidemiology and Prevention in Oncology, CPO Piemonte, WHO Collaborative Center for Cancer Early Diagnosis and Screening, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Rengaswamy Sankaranarayanan
- Screening Group, International Agency for Research on Cancer, Lyon, France; RTI International-India, New Delhi, India
| | - Preetha Rajaraman
- Office of Global Affairs, US Department of Health and Human Services, US Embassy, New Delhi, India
| | - Edward Trimble
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - Stephen Taplin
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - G K Rath
- Rotary Cancer Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ravi Mehrotra
- National Institute of Cancer Prevention and Research, and WHO-Framework Convention on Tobacco Control Smokeless Tobacco Global Knowledge Hub, National Capital Region, India
| |
Collapse
|