Assessing impact of organised breast screening across small residential areas—development and internal validation of a prediction model |
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| Authors: | G. Farshid MBBS MD FRCPA FFSc G. Gill MBBS MD FRACS J. Kollias FRACS MD B. Koczwara BM BS FRACP MBioethics C. Karapetis MBBS FRACP MMedSc J. Adams MBBS PhD FRACP MRCP R. Joshi MBBS MD FRACP D. Keefe PSM MBBS MD FRACP FRCP T. Niyonsenga MSC PhD K. Powell BABus K. Fusco BHlth Sci DipBiomedSc M. Eckert MPH DNurs MN DipAppSc K. Beckmann PhD MPH BSc D. Roder DDSc MPH BDS |
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| Affiliation: | 1. Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia;2. SA Health, BreastScreen SA, Adelaide, SA, Australia;3. Breast Endocrine and Surgical Oncology Unit, RAH, Discipline of Surgery, University of Adelaide, North Terrace, Adelaide, SA, Australia;4. SA Health, Adelaide, SA, Australia;5. Department of Medical Oncology, Flinders University, Adelaide, SA, Australia;6. Medical Oncology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia;7. Royal Adelaide Hospital, Adelaide, SA, Australia;8. South Australian Health & Medical Research Institute, Adelaide, SA, Australia;9. Cancer Nursing, University of South Australia, Adelaide, SA, Australia |
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| Abstract: | Monitoring screening mammography effects in small areas is often limited by small numbers of deaths and delayed effects. We developed a risk score for breast cancer death to circumvent these limitations. Screening, if effective, would increase post‐diagnostic survivals through lead‐time and related effects, as well as mortality reductions. Linked cancer and BreastScreen data at four hospitals (n = 2,039) were used to investigate whether screened cases had higher recorded survivals in 13 small areas, using breast cancer deaths as the outcome (M1), and a risk of death score derived from TNM stage, grade, histology type, hormone receptor status, and related variables (M2). M1 indicated lower risk of death in screened cases in 12 of the 13 areas, achieving statistical significance (p < .05) in 5. M2 indicated lower risk scores in screened cases in all 13 areas, achieving statistical significance in 12. For cases recently screened at diagnosis (<6 months), statistically significant reductions applied in 8 areas (M1) and all 13 areas (M2). Screening effects are more detectable in small areas using these risk scores than death itself as the outcome variable. An added advantage is the application of risk scores for providing a marker of screening effect soon after diagnosis. |
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| Keywords: | breast screening effect monitoring small areas |
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