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Five-year annual incidence and clinico-molecular features of breast cancer after the last negative screening mammography at age 68–69

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Abstract

Objective

The European Commission Initiative on Breast Cancer recommendation for triennial screening of women aged 70–74 is based on very weak evidence. A cohort of Italian women who had their last biennial screening mammography at age 68–69 was followed up for 5 years, assumed to represent the interval to another hypothetical screening mammography, in order to determine the annual proportional incidence of interval breast cancer.

Methods

The cohort included 118,370 women. They had their last mammography between 1997 and 2008. Incident breast cancers were identified by record-linking the cohort with the regional breast cancer registry. The expected incidence in the age range 65–74 was estimated with an age-period-cohort model. The number of interval cancers was divided by the expected number to obtain their proportional incidence.

Results

Overall, there were 298,658 woman-years at risk with 371 interval cancers versus 988.8 expected. In the first, second, third, fourth, and fifth interval year, the proportional incidence was 0.09 (95% confidence interval, 0.06–0.13), 0.32 (0.25–0.39), 0.60 (0.49–0.73), 0.75 (0.60–0.92), and 0.81 (0.60–1.07), respectively. Between the second and the fifth year, tumour stage and molecular subtype did not change significantly.

Conclusion

Though not supported by these findings, the proposal of triennial screening for women aged 70–74 merits further research, because the 95% confidence interval of the third-year proportional incidence of interval cancer included 0.50—the maximum limit considered acceptable for women aged 50–69.

Key Points

• The third-year incidence of breast cancer relative to the expected one was 0.60 (95% confidence interval, 0.49–0.73).

• Between the second and the fifth year, tumour stage and molecular subtype did not change significantly (p >0.10).

• The proposal of a 3-year screening interval at age 70–74 merits further evaluation.

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Abbreviations

APC:

Age-period-cohort

ECIBC:

European Commission Initiative on Breast Cancer

ER+:

Estrogen receptor-positive

EXP:

Expected

HER-:

Human epidermal growth factor receptor 2-negative

HER+:

Human epidermal growth factor receptor 2-positive

OBS:

Observed

PR+:

Progesterone receptor-positive

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Acknowledgements

The members of the Emilia-Romagna Region Workgroup for Mammography Screening Evaluation are as follows: Stefano Ferretti (University of Ferrara and Local Health Authority, Ferrara, Italy); Nicoletta Bertozzi, Enza Di Felice, Alba Carola Finarelli, Carlo Naldoni, Priscilla Sassoli de Bianchi (Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy); Flavia Baldacchini, Lauro Bucchi, Orietta Giuliani, Silvia Mancini, Alessandra Ravaioli, Rosa Vattiato (Romagna Cancer Institute, IRST, IRCCS, Meldola, Forlì, Italy); Fabio Falcini (Romagna Cancer Institute, IRCCS IRST “Dino Amadori”), Meldola, Forlì, and Local Health Authority, Forlì, Italy); Elisabetta Borciani, Giorgio Celoni, Giorgio Gatti, Rosella Schianchi (Local Health Authority, Piacenza, Italy); Nicoletta Piazza, Marella Zatelli (Local Health Authority, Parma, Italy); Paolo Giorgi Rossi (Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy); Cinzia Campari, Antonella Cattani, Luisa Paterlini (Cancer Screening Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy); Carlo Alberto Mori, Rita Vacondio (Cancer Screening Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy); Valeria Bellelli, Giuliano Carrozzi, Rossella Corradini, Claudia Mauri, Rossella Negri (Local Health Authority, Modena, Italy); Carmen Bazzani, Marilena Manfredi, Francesca Mezzetti, Adriana Pasquini, Gianni Saguatti (Local Health Authority, Bologna, Italy); Licia Caprara, Stefania Cortecchia, Margherita De Lillo, Roberto Nannini (Local Health Authority, Imola, Italy); Giorgio Benea, Aldo De Togni, Caterina Palmonari, Roberto Pasqualini (Local Health Authority, Ferrara, Italy); Patrizia Bravetti, Monica Serafini, Benedetta Vitali (Local Health Authority, Ravenna, Italy); Antonella Bagni, Claudia Imolesi, Mauro Palazzi (Local Health Authority, Cesena, Italy); Debora Canuti, Lorenzo Menghini, Giancarla Monticelli (Local Health Authority, Rimini, Italy).

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”), Meldola, Forlì, Italy

    Lauro Bucchi, Alessandra Ravaioli, Flavia Baldacchini, Orietta Giuliani, Silvia Mancini, Rosa Vattiato & Fabio Falcini

  2. Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Paolo Giorgi Rossi

  3. Cancer Screening Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Cinzia Campari

  4. Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy

    Debora Canuti, Enza Di Felice, Priscilla Sassoli de Bianchi & Nicoletta Bertozzi

  5. University of Ferrara and Local Health Authority, Ferrara, Italy

    Stefano Ferretti

  6. Local Health Authority, Forlì, Italy

    Fabio Falcini

Authors
  1. Lauro Bucchi
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  2. Alessandra Ravaioli
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  3. Flavia Baldacchini
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  4. Orietta Giuliani
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  5. Silvia Mancini
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  6. Rosa Vattiato
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  7. Paolo Giorgi Rossi
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  8. Cinzia Campari
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  9. Debora Canuti
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  10. Enza Di Felice
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  11. Priscilla Sassoli de Bianchi
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  12. Stefano Ferretti
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  13. Nicoletta Bertozzi
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  14. Fabio Falcini
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Consortia

on behalf of the Emilia-Romagna Region Workgroup for Mammography Screening Evaluation

Corresponding author

Correspondence to Alessandra Ravaioli.

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Guarantor

The scientific guarantor of this publication is Lauro Bucchi.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Three of the authors have significant statistical expertise.

Informed consent

Written informed consent was not required for this study because of its retrospective nature.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Multicenter study

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Supplementary information

ESM 1

Age-period-cohort models for trends in incidence of breast cancer in Emilia-Romagna region from 1992 to 2008 (population aged 40–79 years) (DOCX 119 kb)

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Bucchi, L., Ravaioli, A., Baldacchini, F. et al. Five-year annual incidence and clinico-molecular features of breast cancer after the last negative screening mammography at age 68–69. Eur Radiol 32, 834–841 (2022). https://doi.org/10.1007/s00330-021-08129-9

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  • DOI: https://doi.org/10.1007/s00330-021-08129-9

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