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Annals of Oncology Advance Access originally published online on March 12, 2009
Annals of Oncology 2009 20(7):1199-1202; doi:10.1093/annonc/mdn770
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

breast cancer

Effectiveness of organised versus opportunistic mammography screening

J.-L. Bulliard1,*, C. Ducros2, C. Jemelin3, B. Arzel4, G. Fioretta5 and F. Levi1,6

1 Cancer Epidemiology Unit, University Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne
2 Breast Cancer Screening Foundation, Lausanne
3 Valais Breast Cancer Screening Centre, Sion
4 Geneva Breast Cancer Screening Foundation, Geneva
5 Geneva Cancer Registry, Institute of Social and Preventive Medicine, Geneva University, Geneva
6 Vaud Cancer Registry, University Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

* Correspondence to: Dr J.-L. Bulliard, Unité d'épidémiologie du cancer, Institut de médecine sociale et préventive, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, rue du Bugnon 17, 1005 Lausanne, Switzerland. Tel: +41-21-3147245; Fax: +41-21-314-7373; E-mail: Jean-Luc.Bulliard{at}chuv.ch

Background: Detailed comparison of effectiveness between organised and opportunistic mammography screening operating in the same country has seldom been carried out.

Patients and methods: Prognostic indicators, as defined in the European Guidelines, were used to evaluate screening effectiveness in Switzerland. Matching of screening programmes’ records with population-based cancer registries enabled to compare indicators of effectiveness by screening and detection modality (organised versus opportunistic screening, unscreened, interval cancers). Comparisons of prognostic profile were also drawn with two Swiss regions uncovered by service screening of low and high prevalence of opportunistic screening, respectively.

Results: Opportunistic and organised screening yielded overall little difference in prognostic profile. Both screening types led to substantial stage shifting. Breast cancer prognostic indicators were systematically more favourable in Swiss regions covered by a programme. In regions without a screening programme, the higher the prevalence of opportunistic screening, the better was the prognostic profile.

Conclusions: Organised screening appeared as effective as opportunistic screening. Mammography screening has strongly influenced the stage distribution of breast cancer in Switzerland, and a favourable impact on mortality is anticipated. Extension of organised mammography screening to the whole of Switzerland can be expected to further improve breast cancer prognosis in a cost-effective way.

Key words: breast cancer, effectiveness, mammography screening, Switzerland

Received for publication November 7, 2008. Accepted for publication December 1, 2008.


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Organized and opportunistic screening
Alain Braillon
Annals of Oncology, 3 Jul 2009 [Full text]

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