Effectiveness of Organized Mammography Screening for Different Breast Cancer Molecular Subtypes

• Published in: Cancers Vol. 14; no. 19; p. 4831
• Main Authors: Ding, Lilu, Greuter, Marcel J. W, Truyen, Inge, Goossens, Mathijs, Van der Vegt, Bert, De Schutter, Harlinde, Van Hal, Guido, de Bock, Geertruida H
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01.10.2022; MDPI
• Subjects: Age; biomarkers; Breast cancer; breast neoplasms; Diagnosis; early detection of cancer; Epidermal growth factor; ErbB-2 protein; Genetic aspects; immunohistochemistry; Invasiveness; Mammography; Medical diagnosis; Medical screening; Methods; Mortality; Participation; Performance evaluation; Population; Regression analysis; social participation; Womens health; Netherlands
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers14194831

Background: Screening program effectiveness is generally evaluated for breast cancer (BC) as one disease and without considering the regularity of participation, while this might have an impact on detection rate. Objectives: To evaluate the short-term effectiveness of a mammography screening program for the major molecular subtypes of invasive BC. Methods: All women who participated in the screening program and were diagnosed with screen-detected or interval BC in Flanders were included in the study (2008–2018). Molecular subtypes considered were luminal and luminal-HER2-positive, human epidermal growth factor receptor 2-positive, and triple-negative BC (TNBC). The relationship between the BC stage at diagnosis (early (I–II) versus advanced (III–IV)) and the method of detection (screen-detected or interval) and the relationship between the method of detection and participation regularity (regular versus irregular) were evaluated by multi-variable logistic regression models. All models were performed for each molecular subtype and adjusted for age. Results: Among the 12,318 included women, BC of luminal and luminal-HER2-positive subtypes accounted for 70.9% and 11.3%, respectively. Screen-detected BC was more likely to be diagnosed at early stages than interval BC with varied effect sizes for luminal, luminal-HER2-positive, and TNBC with OR:2.82 (95% CI: 2.45–3.25), OR:2.39 (95% CI: 1.77–3.24), and OR:2.29 (95% CI: 1.34–4.05), respectively. Regular participation was related to a higher likelihood of screening detection than irregular participation for luminal, luminal-HER2-positive, and TNBC with OR:1.21 (95% CI: 1.09–1.34), OR: 1.79 (95% CI: 1.38–2.33), and OR: 1.62 (95% CI: 1.10–2.41), respectively. Conclusions: Regular screening as compared to irregular screening is effective for all breast cancers except for the HER2 subtype.