Effects of Screening and Systemic Adjuvant Therapy on ER-Specific US Breast Cancer Mortality

D Munoz, AM Near, Nicolien van Ravesteyn, Sven van der Lee, CB Schechter, O Alagoz, DA Berry, ES Burnside, YJ Chang, G Chisholm, Harry de Koning, MA Ergun, Eveline Heijnsdijk, H Huang, NK Stout, BL Sprague, A Trentham-Dietz, JS Mandelblatt, SK Plevritis

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Background Molecular characterization of breast cancer allows subtype-directed interventions. Estrogen receptor (ER) is the longest-established molecular marker. Methods We used six established population models with ER-specific input parameters on age-specific incidence, disease natural history, mammography characteristics, and treatment effects to quantify the impact of screening and adjuvant therapy on age-adjusted US breast cancer mortality by ER status from 1975 to 2000. Outcomes included stage-shifts and absolute and relative reductions in mortality; sensitivity analyses evaluated the impact of varying screening frequency or accuracy. Results In the year 2000, actual screening and adjuvant treatment reduced breast cancer mortality by a median of 17 per 100 000 women (model range = 13-21) and 5 per 100 000 women (model range = 3-6) for ER-positive and ER-negative cases, respectively, relative to no screening and no adjuvant treatment. For ER-positive cases, adjuvant treatment made a higher relative contribution to breast cancer mortality reduction than screening, whereas for ER-negative cases the relative contributions were similar for screening and adjuvant treatment. ER-negative cases were less likely to be screen-detected than ER-positive cases (35.1% vs 51.2%), but when screen-detected yielded a greater survival gain (five-year breast cancer survival = 35.6% vs 30.7%). Screening biennially would have captured a lower proportion of mortality reduction than annual screening for ER-negative vs ER-positive cases (model range = 80.2%-87.8% vs 85.7%-96.5%). Conclusion As advances in risk assessment facilitate identification of women with increased risk of ER-negative breast cancer, additional mortality reductions could be realized through more frequent targeted screening, provided these benefits are balanced against screening harms.
Original languageUndefined/Unknown
JournalJournal of the National Cancer Institute
Issue number11
Publication statusPublished - 2014

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