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Advanced breast cancer more common in area with low uptake of screening

Roger Dobson Abergavenny

Death rates from breast cancer in one NHS screening programme area were nearly double that of the neighbouring area, a new study has found.

A low uptake of screening invitations may be to blame for the higher levels of advanced breast cancer disease and increased mortality in the area with the lower uptake.

The study, which compared NHS programmes in Wigan and Manchester, found that the incidence of advanced disease in the low uptake area, Manchester, was almost double that of Wigan, where the proportion of women accepting invitations was much higher. The study found a similar trend in mortality from breast cancer.

"This is the first report of long-term outcomes from breast cancer in women invited for NHS screening and shows a significant difference in the rate of advanced disease between two programmes with different cancer detection and attendance rates," says a report of the study in the British Journal of Cancer (2003;89:77-80).

The authors, from the Centre for Cancer Epidemiology at the University of Manchester, followed up women who were aged 54 or under when they were first invited for NHS breast screening in 1989 and 1990.

The study centred on 5125 women invited for multiple rounds of breast screening by the Wigan screening programme, and 10 750 women invited by the Manchester programme. The main outcome measures were rates of advanced disease and mortality from breast cancer

The uptake for all invitations to screening was found to be 79% in Wigan and 51% in Manchester.

The results show that, although the incidence of invasive cancer was higher in Wigan than in Manchester, the rate of advanced disease was significantly lower. Mortality was also lower in Wigan than in Manchester (2.46 v 4.31 per 10 000 person years) and remained lower after the researchers excluded data for women found to have cancer at the first screening round.

In Manchester, 22% of the invasive cancers that were diagnosed during the 10 years of follow up were advanced cancers, whereas in Wigan the proportion was only 10%.

"More effective screening, either as a result of higher detection rates or greater attendance at screening, is the most likely explanation for the lower rate of advanced disease in Wigan. The low rate of advanced disease observed in the Wigan programme indicates what can be achieved with high cancer detection rates and regular attendance at screening," the authors wrote.

Lead author Dr Anthony Threlfall said, "The trick seems to be to getting women to attend their first screen, as once they’ve attended a screen most will continue to attend all their screens. The message we have to get across is that two thirds of the deaths we observed were due to very late stage disease mainly in women who don’t attend all their screens. If you do turn up every three years you lessen the opportunity of presenting with very advanced disease. You may get a cancer within the three years, but it is likely to be treatable. With improvements in treatment it is delaying diagnosis and presenting with advanced disease that is the killer."

© 2003 BMJ Publishing Group Ltd