The contribution of mammography screening to breast cancer incidence trends in the United States: an updated age-period-cohort model

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Ronald E GangnonAmy Trentham-Dietz

Abstract

The impact of screening mammography on breast cancer incidence is difficult to disentangle from cohort- and age-related effects on incidence. We developed an age-period-cohort model of ductal carcinoma in situ (DCIS) and invasive breast cancer incidence in U.S. females using cancer registry data. Five functions were included in the model to estimate stage-specific effects for age, premenopausal birth cohorts, postmenopausal birth cohorts, period (for all years of diagnosis), and a mammography period effect limited to women ages ≥ 40 years after 1982. Incidence with and without the mammography period effect was calculated. More recent birth cohorts have elevated underlying risk compared with earlier cohorts for both pre- and postmenopausal women. Comparing models with and without the mammography period effect showed that overall breast cancer incidence would have been 23.1% lower in the absence of mammography in 2010 (95% confidence intervals, 18.8-27.4), including 14.7% (9.5-19.3) lower for invasive breast cancer and 54.5% (47.4-59.6) lower for DCIS. Incidence of distant-staged breast cancer in 2010 would have been 29.0% (13.1-48.1) greater in the absence of mammography screening. Mammography contributes to markedly elevated ra...Continue Reading

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