Impact of Breast Cancer Screening on 10-Year Net Survival in Canadian Women Age 40-49 Years

Anna N Wilkinson; Larry F Ellison; Jean-Michel Billette; Jean M Seely

doi:10.1200/JCO.23.00348

Impact of Breast Cancer Screening on 10-Year Net Survival in Canadian Women Age 40-49 Years

J Clin Oncol. 2023 Oct 10;41(29):4669-4677. doi: 10.1200/JCO.23.00348. Epub 2023 Aug 4.

Authors

Anna N Wilkinson¹, Larry F Ellison², Jean-Michel Billette², Jean M Seely³

Affiliations

¹ Department of Family Medicine, University of Ottawa.
² Centre for Population Health Data at Statistics Canada, Government of Canada, Ottawa, Canada.
³ University of Ottawa, Department of Radiology, Ottawa Hospital Research Institute, Ottawa, Canada.

Abstract

Purpose: In Canada, some provincial/territorial mammography screening programs include women age 40-49 years, whereas others do not. This study examines the impact of this dichotomy on the 10-year breast cancer (BC) net survival (NS) among women age 40-49 years and 50-59 years at diagnosis.

Methods: Using the Canadian Cancer Registry data record linked to death information, we evaluated the cohort of Canadian women age 40-49 years and 50-59 years diagnosed with BC from 2002 to 2007. We compared 10-year NS estimates in the jurisdictions with organized screening programs that included women age 40-49 years, designated as screeners (Northwest Territories, British Columbia, Alberta, Nova Scotia, and Prince Edward Island), with comparator programs that did not (Yukon, Manitoba, Saskatchewan, Ontario, Quebec, New Brunswick, and Newfoundland and Labrador).

Results: BC was the primary cause of 10-year mortality in women age 40-49 years diagnosed with BC (90.7% of deaths). Among these women, the 10-year NS for screeners (84.8%; 95% CI, 83.8 to 85.8) was 1.9 percentage points (pp) higher than that for comparators (82.9%; 95% CI, 82.3 to 83.5; P = .001). The difference in favor of screeners was significant among women age 45-49 years (2.6 pp; P = .001) but not among women age 40-44 years (0.9 pp; P = .328). Similarly, the incidence-based BC mortality rate was significantly lower in screener jurisdictions among women age 40-49 years and 45-49 years, but not for 40-44 years. Provincial/territorial NS increased significantly with higher mammography screening participation (P = .003). The BC incidence rate was virtually identical in screener and comparator jurisdictions among women age 40-49 years (P = .976) but was significantly higher for comparators among women age 50-59 years (P < .001).

Conclusion: Screening programs that included women in their 40s were associated with a significantly higher BC 10-year NS in women age 40-49 years, but not an increased rate of BC diagnosis. These results may inform screening guidelines for women age 40-49 years.