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Open Access Highly Accessed Research article

Effectiveness of early detection on breast cancer mortality reduction in Catalonia (Spain)

Montserrat Rue12*, Ester Vilaprinyo3, Sandra Lee4, Montserrat Martinez-Alonso1, Misericordia Carles5, Rafael Marcos-Gragera67, Roger Pla8 and Josep-Alfons Espinas7

Author Affiliations

1 Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain

2 University of Lleida, Lleida, Catalonia, Spain

3 Fundation Dr. Ferran, Hospital of Tortosa, Catalonia, Spain

4 Dana Farber Cancer Institute, Boston, USA

5 Rovira i Virgili University, Reus, Catalonia, Spain

6 Girona Cancer Registry, Girona, Catalonia, Spain

7 Catalan Cancer Plan. Department of Health, Catalonia, Spain

8 Catalan Institute of Health, Terres de l'Ebre Region, Catalonia, Spain

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BMC Cancer 2009, 9:326  doi:10.1186/1471-2407-9-326

Published: 15 September 2009

Abstract

Background

At present, it is complicated to use screening trials to determine the optimal age intervals and periodicities of breast cancer early detection. Mathematical models are an alternative that has been widely used. The aim of this study was to estimate the effect of different breast cancer early detection strategies in Catalonia (Spain), in terms of breast cancer mortality reduction (MR) and years of life gained (YLG), using the stochastic models developed by Lee and Zelen (LZ).

Methods

We used the LZ model to estimate the cumulative probability of death for a cohort exposed to different screening strategies after T years of follow-up. We also obtained the cumulative probability of death for a cohort with no screening. These probabilities were used to estimate the possible breast cancer MR and YLG by age, period and cohort of birth. The inputs of the model were: incidence of, mortality from and survival after breast cancer, mortality from other causes, distribution of breast cancer stages at diagnosis and sensitivity of mammography. The outputs were relative breast cancer MR and YLG.

Results

Relative breast cancer MR varied from 20% for biennial exams in the 50 to 69 age interval to 30% for annual exams in the 40 to 74 age interval. When strategies differ in periodicity but not in the age interval of exams, biennial screening achieved almost 80% of the annual screening MR. In contrast to MR, the effect on YLG of extending screening from 69 to 74 years of age was smaller than the effect of extending the screening from 50 to 45 or 40 years.

Conclusion

In this study we have obtained a measure of the effect of breast cancer screening in terms of mortality and years of life gained. The Lee and Zelen mathematical models have been very useful for assessing the impact of different modalities of early detection on MR and YLG in Catalonia (Spain).