population-based service mammography screening: the icelandic experience

Kristjan Sigurdsson,1,3 Elínborg Jóna Ólafsdóttir,21The Icelandic Cancer Detection Clinic, 2The Icelandic Cancer Registry, Icelandic Cancer Society, 3Faculty of Medicine, University of Iceland, Reykjavik, IcelandObjective: This study analyzes the efficacy of the Icelandic population-based service mammography screening.Material and methods: Women aged 40–69 were invited for screening at 2-year intervals starting in November 1987. The study evaluates: (A) attendance and other screened performance parameters during 1998–2010; (B) trends in age-standardized and age-specific incidence rates during 1969–2010 and mortality rates during 1969–2010; and (C) distribution of risk factors and disease specific death rates according to mode of detection.Results: (A) In the age group of 40–69, the average 2-year attendance was 62%, recall rate was 4.1%, needle biopsy rate was 1.3%, surgery rate was 0.6%, invasive cancer rate was 0.4%, and ductal carcinoma in situ (DCIS) rate was 0.06%. (B) The linear incidence trend after the start of screening decreased significantly in the age group 40–49, increased significantly in the age group 50–69, but decreased non-significantly in the age group 70–79. The decreased age-specific incidence in the 70–79 age group was, however, greater than the increased age-specific incidence at the ages 50–69. The mortality rate decreased 41% for all age groups and the linear mortality trend decreased significantly at ages 40–49, 50–69, and 70–79. In the age group 40–74 years, the age-specific mortality decreased by 6.9 cases per 2000 during a 10-year period. (C) Screen-detected women had significantly smaller tumors, more favorable tumor grade, fewer axillary metastases and, after correction for other risk factors, the likelihood of dying from cancer decreased 54% (hazard ratio: 0.46; 95% confidence interval: 0.31–0.69) for these patients compared to cases of nonparticipators.Conclusion: The study results confirm acceptable rates of recalls and referrals for further diagnosis and treatment, and significantly decreased breast cancer mortality rate after starting screening.Keywords: mammography, screening, breast cancer, mortality, incidence, mode of detection, risk factors