© 2005 Oxford University Press
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Efficacy of Breast Cancer Screening in the Community According to Risk Level
Affiliations of authors: School of Medicine, Harborview Medical Center, University of Washington, Seattle, WA (JGE, LMR); Center for Health Studies, Group Health Cooperative, Seattle, WA (JGE, WEB, RKB, GH, OY, SMG); Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA (JGE, NSW); Center for Health Research, Kaiser Permanente, Portland, OR (ELH); HealthPartners Research Foundation, Minneapolis, MN (SR); Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Boston, MA (MBB, SWF); Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA (AMG); Division of Research, Kaiser Permanente Northern California, Oakland, CA (LJH); Biostatistics Department, School of Public Health and Community Medicine, University of Washington, Seattle, WA (WEB); Cancer Research and Biostatistics, University of Washington, Seattle, WA (WEB)
Correspondence to: Joann G. Elmore, MD, MPH, Professor, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave., Box 359780, Seattle, Washington 98104–2499 (e-mail: jelmore{at}u.washington.edu).
Background: The efficacy of breast cancer screening in the community may differ from that suggested by the results of randomized trials, and no data have been available on efficacy among women who have different levels of breast cancer risk. Methods: We conducted a matched case–control study among women enrolled in six health plans in Washington, Oregon, California, Massachusetts, and Minnesota. We examined the efficacy of screening by mammography and/or clinical breast examination among women in two age cohorts (40–49 years and 50–65 years) and in two breast cancer risk levels (average and increased risk). Women who died from breast cancer from January 1, 1983, through December 31, 1998, (N = 1351; case subjects) were matched to control subjects (N = 2501) on age and risk level. Increased risk was defined as a family history of breast cancer or a breast biopsy noted in the medical records before the index date (defined as date of first suspicion of breast abnormalities in case subjects, with the same date used for matched control subjects). Data on screening, risk status, and other variables were abstracted from medical records. Conditional logistic regression was used to examine the association between breast cancer mortality and receipt of screening. All statistical tests were two-sided. Results: There were small, non-statistically significant associations between breast cancer mortality and receipt of screening during the 3 years prior to the index date for both the younger women [odds ratio (OR) = 0.92; 95% confidence interval (CI) = 0.76 to 1.13] and the older women (OR = 0.87; 95% CI = 0.68 to 1.12). The association among women at increased risk (OR = 0.74; 95% CI = 0.50 to 1.03) was stronger than that among women at average risk (OR = 0.96; 95% CI = 0.80 to 1.14), but the difference was not statistically significant (P = .17). Conclusions: In this community-based study, screening history was not associated with breast cancer mortality. However, potential limitations of this study argue for a cautious interpretation of these findings.
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Correspondence about this Article
- Re: Efficacy of Breast Cancer Screening in the Community According to Risk Level
- Stephen W. Duffy, Robert A. Smith, and Laszlo Tabar
J Natl Cancer Inst 2005 97: 1703.[Extract] [Full Text] [PDF]
- Re: Efficacy of Breast Cancer Screening in the Community According to Risk Level
- Eugenio Paci and Marco Zappa
J Natl Cancer Inst 2005 97: 1704.[Extract] [Full Text] [PDF]
Editorial about this Article
- Effectiveness: The Next Question for Breast Cancer Screening
- Russell Harris
J Natl Cancer Inst 2005 97: 1021-1023.[Extract] [Full Text] [PDF]
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