Digital mammography screening in Germany: Impact of age and histological subtype on program sensitivity

Breast. 2015 Jun;24(3):191-6. doi: 10.1016/j.breast.2014.12.009. Epub 2015 Feb 14.

Abstract

Introduction: Program sensitivity (PS), i.e., the ratio of screen-detected cancers divided by the sum of screen-detected plus interval cancers, is a major outcome in population-based mammography screening programs (MSP). This study evaluated PS within the digital MSP in Germany focussing on the impact of age and histological subtype.

Methods: Data of 838,579 first-time participants aged 50-69 years who were screened in 2005-2008 were linked with cancer registry data from Germany's most populous state, North Rhine-Westphalia. Invasive breast cancers and ductal carcinomas in situ (DCIS) were detected either at screening or during the 24 month post-screening interval. PS was evaluated with respect to age at screening, in-situ or invasive cancer and histological characteristics.

Results: In total, 6767 cancers were detected at screening and 1884 cancers were diagnosed during the post-screening interval. The overall PS amounted to 78.2% and increased from 72.1% at age 50-54 years to 82.4% at age 65-69 years (p for trend <0.0001). PS was higher for non-lobular (79.1%) than lobular carcinomas (72.1%, p < 0.0001). The highest PS was observed in DCIS across all ages (>90%), while PS was lowest among participants aged 50-54 years with invasive breast cancer (67.7%), particularly among those with lobular subtype (62.8%). Interval cancers showed generally more advanced tumour stages.

Conclusions: While overall PS was high, differences across subgroups indicated that youngest screening participants are at higher risk of interval cancer. Age-adapted recall and assessment strategies in younger participants may need to be considered to improve PS in younger women.

Keywords: Breast cancer; Cancer registry; Digital mammography screening; Germany; Interval cancer; Program sensitivity.

Publication types

  • Evaluation Study

MeSH terms

  • Age Factors
  • Aged
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / pathology
  • Carcinoma, Ductal, Breast / diagnostic imaging*
  • Carcinoma, Ductal, Breast / epidemiology
  • Carcinoma, Lobular / diagnostic imaging*
  • Carcinoma, Lobular / epidemiology
  • Early Detection of Cancer / statistics & numerical data*
  • Female
  • Germany / epidemiology
  • Humans
  • Mammography / methods
  • Mammography / statistics & numerical data*
  • Middle Aged
  • Program Evaluation / statistics & numerical data*
  • Registries
  • Sensitivity and Specificity