Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2015

Open Access 01-12-2015 | Research article

Evaluation of health benefits and harms of the breast cancer screening programme in the Basque Country using discrete event simulation

Authors: Arantzazu Arrospide, Montserrat Rue, Nicolien T. van Ravesteyn, Merce Comas, Nerea Larrañaga, Garbiñe Sarriugarte, Javier Mar

Published in: BMC Cancer | Issue 1/2015

Login to get access

Abstract

Background

Since the breast cancer screening programme in the Basque Country (BCSPBC) was started in 1996, more than 400,000 women aged 50 to 69 years have been invited to participate. Based on epidemiological observations and simulation techniques it is possible to extend observed short term data into anticipated long term results. The aim of this study was to assess the effectiveness of the programme through 2011 by quantifying the outcomes in breast cancer mortality, life-years gained, false positive results, and overdiagnosis.

Methods

A discrete event simulation model was constructed to reproduce the natural history of breast cancer (disease-free, pre-clinical, symptomatic, and disease-specific death) and the actual observed characteristics of the screening programme during the evaluated period in the Basque women population. Goodness-of-fit statistics were applied for model validation. The screening effects were measured as differences in benefits and harms between the screened and unscreened populations. Breast cancer mortality reduction and life-years gained were considered as screening benefits, whereas, overdiagnosis and false positive results were assessed as harms. Results for a single cohort were also obtained.

Results

The screening programme yielded a 16 % reduction in breast cancer mortality and a 10 % increase in the incidence of breast cancer through 2011. Almost 2 % of all the women in the programme had a false positive result during the evaluation period. When a single cohort was analysed, the number of deaths decreased by 13 %, and 4 % of screen-detected cancers were overdiagnosed. Each woman with BC detected by the screening programme gained 2.5 life years due to early detection corrected by lead time.

Conclusions

Fifteen years after the screening programme started, this study supports an important decrease in breast cancer mortality due to the screening programme, with reasonable risk of overdiagnosis and false positive results, and sustains the continuation of the breast cancer screening programme in the Basque population.
Appendix
Available only for authorised users
Literature
1.
Wilson JM, Jungner G. Principles and practice of screening for disease. Public Health Papers 34. Geneva: World Health Organisation; 1968.
2.
Puliti D, Duffy SW, Miccinesi G, De Koning H, Lynge E, Zappa M, et al. Overdiagnosis in mammographic screening for breast cancer in Europe: a literature review. J Med Screen. 2012;19 Suppl 1:42–56.CrossRefPubMed
3.
Nyström L, Andersson I, Bjurstam N, Frisell J, Nordenskjöld B, Rutqvist LE. Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet. 2002;359:909–19.CrossRefPubMed
4.
Bjurstam N, Bjorneld L, Warwick J, Sala E, Duffy SW, Nystrom L, et al. The Gothenburg Breast Screening Trial. Cancer. 2003;97:2387–96.CrossRefPubMed
5.
Arrospide A, Forne C, Rue M, Tora N, Mar J, Bare M. An assessment of existing models for individualized breast cancer risk estimation in a screening program in Spain. BMC Cancer. 2013;13:587.CrossRefPubMedPubMedCentral
6.
7.
Smith RA. The value of modern mammography screening in the control of breast cancer: understanding the underpinnings of the current debates. Cancer Epidemiol Biomarkers Prev. 2014;23:1139–46.CrossRefPubMed
8.
Biller-Andorno N, Juni MD. Abolishing Mammography Screening Programs? A View from the Swiss Medical Board. N Engl J Med. 2014;370(21):1965–7.CrossRefPubMed
9.
Biller-Andorno N, Cignacco E, Felder S, Juni P, Meier-Abt P, Metzger U, et al. Dépistage systématique par mammographie. Zollikon: Swiss Medical Board; 2013.
10.
Hackshaw A. The benefits and harms of mammographic screening for breast cancer: building the evidence base using service screening programmes. J Med Screen. 2012;19 Suppl 1:1–2.CrossRefPubMed
11.
Villalbi JR, Tresserras R. Evaluación de políticas y planes de salud. Gac Sanit. 2011;25:17–24.CrossRefPubMed
12.
Weatherly H, Drummond M, Claxton K, Cookson R, Ferguson B, Godfrey C, et al. Methods for assessing the cost-effectiveness of public health interventions: key challenges and recommendations. Health Policy. 2009;93:85–92.CrossRefPubMed
13.
Perry N, Broeders M, De Wolf C, Törnberg S, Holland R, Von Karsa L. European guidelines for quality assurance in breast cancer screening and diagnosis. Heath Consumer Protection (ed). Luxembourg: Office for Official Publications of the European Communities; 2006.
14.
Comas M, Arrospide A, Mar J, Sala M, Vilaprinyo E, Hernandez C, et al. Budget impact analysis of switching to digital mammography in a population-based breast cancer screening program: a discrete event simulation model. PLoS One. 2014;9:e97459.CrossRefPubMedPubMedCentral
15.
Gunsoy NB, Garcia-Closas M, Moss SM. Estimating breast cancer mortality reduction and overdiagnosis due to screening for different strategies in the United Kingdom. Br J Cancer. 2014;110:2412–9.CrossRefPubMedPubMedCentral
16.
Rojnik K, Naversnik K, Mateovic-Rojnik T, Primiczakelj M. Probabilistic cost-effectiveness modeling of different breast cancer screening policies in Slovenia. Value Health. 2008;11:139–48.CrossRefPubMed
17.
Vilaprinyo E, Forne C, Carles M, Sala M, Pla R, Castells X, et al. Cost-effectiveness and harm-benefit analyses of risk-based screening strategies for breast cancer. PloS One. 2014;9(2):e86858.CrossRefPubMedPubMedCentral
18.
van Oortmarssen GJ, Habbema JD, van der Maas PJ, de Koning HJ, Collette HJ, Verbeek AL, et al. A model for breast cancer screening. Cancer. 1990;66(7):1601–12.CrossRefPubMed
19.
Karnon J, Stahl J, Brennan A, Caro JJ, Mar J, Moller J, et al. Modeling using discrete event simulation: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--4. Value Health. 2012;15:821–7.CrossRefPubMed
20.
21.
Hoyle M, Anderson R. Whose costs and benefits? Why economic evalution should simulate both prevalent and all future incident patient cohorts. Med Decis Making. 2010;30:426–37.CrossRefPubMed
22.
Izarzugaza MI, Martinez R, Audicana C, Larrañaga N, Henandez E, Tobalina MC, et al. Cancer in the Basque Country: Incidence, mortality, survival and their trends. Vitoria-Gasteiz: Department of Health and Consumer Affairs, Basque Country Administration; 2010.
23.
Vilaprinyo E, Gispert R, Martinez-Alonso M, Carles M, Pla R, Espinas JA, et al. Competing risks to breast cancer mortality in Catalonia. BMC Cancer. 2008;8:331–8.CrossRefPubMedPubMedCentral
24.
Lee S, Zelen M. A stochastic model for predicting the mortality of breast cancer. J Natl Cancer Inst Monogr. 2006;36:79–86.CrossRefPubMed
25.
Rue M, Vilaprinyo E, Lee S, Martinez-Alonso M, Carles MD, Marcos-Gragera R, et al. Effectiveness of early detection on breast cancer mortality reduction in Catalonia (Spain). BMC Cancer. 2009;9:326–35.CrossRefPubMedPubMedCentral
26.
Vilaprinyo E, Rue M, Marcos-Gragera R, Martinez-Alonso M. Estimation of age- and stage-specific Catalan breast cancer survival functions using US and Catalan survival data. BMC Cancer. 2009;9:98–111.CrossRefPubMedPubMedCentral
27.
Arrospide A, Soto-Gordoa M, Acaiturri T, Lopez-Vivanco G, Abecia LC, Mar J. The cost of breast cancer treatment by clinical stage in the Basque Country, Spain. Rev Esp Salud Pública. 2015;1:89–93.
28.
29.
30.
Asmussen S, Glynn P. Steady-State Simulation. Stochastic Simulation: Algorithms and Analysis. New York.: Springer; 2007.
31.
Ormiston-Smith N, Scowcroft H, Thomson CS. Mortality benefits and overdiagnosis estimates for women attending breast screening. Br J Cancer. 2013;108:2413–24.CrossRefPubMedPubMedCentral
32.
Boer R, Warmerdam P, De Koning H, Van Oortmarssen G. Extra incidence caused by mammographic screening. Lancet. 1994;343:979.CrossRefPubMed
33.
De Gelder R, Heijnskijk EA, Van Ravesteyn NT, Fracheboud J, Draisma G, De Koning H. Interpreting overdiagnosis estimates in population-based mammography screening. Epidemiol Rev. 2011;33:111–21.CrossRefPubMedPubMedCentral
34.
Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer. 2013;108:2205–40.CrossRefPubMedPubMedCentral
35.
Hofvind S, Ponti A, Patnick J, Ascunce N, Njor S, Broeders M, et al. False-positive results in mammographic screening for breast cancer in Europe: a literature review and survey of service screening programmes. J Med Screen. 2012;19 Suppl 1:57–66.CrossRefPubMed
36.
Otten JD, Fracheboud J, Den Heeten GJ, Otto SJ, Holland R, De Koning HJ, et al. Likelihood of early detection of breast cancer in relation to false-positive risk in life-time mammographic screening: population-based cohort study. Ann Oncol. 2013;24:2501–6.CrossRefPubMed
37.
Baltussen R, Niessen L. Priority setting of health interventions: the need for multi-criteria decision analysis. Cost Eff Resour Alloc. 2006;4:14–22.CrossRefPubMedPubMedCentral
38.
Cronin KA, Feuer EJ, Clarke LD, Plevritis SK. Impact of adjuvant therapy and mammography on U.S. mortality from 1975 to 2000: comparison of mortality results from the cisnet breast cancer base case analysis. J Natl Cancer Inst Monogr. 2006;36:112–21.CrossRefPubMed
39.
Broeders M, Moss S, Nystrom L, Njor S, Jonsson H, Paap E, et al. The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies. J Med Screen. 2012;19 Suppl 1:14–25.CrossRefPubMed
40.
Carles M, Vilaprinyo E, Cots F, Gregori A, Pla R, Roman R, et al. Cost-effectiveness of early detection of breast cancer in Catalonia (Spain). BMC Cancer. 2011;11:192–203.CrossRefPubMedPubMedCentral
41.
Duffy SW, Parmar D. Overdiagnosis in breast cancer screening: the importance of length of observation period and lead time. Breast Cancer Res. 2013;15:R41.CrossRefPubMedPubMedCentral
42.
Yen AM, Duffy SW, Chen TH, Chen LS, Chiu SY, Fann JC, et al. Long-term incidence of breast cancer by trial arm in one county of the Swedish Two-County Trial of mammographic screening. Cancer. 2012;118(23):5728–32.CrossRefPubMed
43.
Eddy DM, Hollingworth W, Caro JJ, Tsevat J, McDonald KM, Wong JB, et al. Model transparency and validation: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--7. Value Health. 2012;15:843–50.CrossRefPubMed
Metadata
Title
Evaluation of health benefits and harms of the breast cancer screening programme in the Basque Country using discrete event simulation
Authors
Arantzazu Arrospide
Montserrat Rue
Nicolien T. van Ravesteyn
Merce Comas
Nerea Larrañaga
Garbiñe Sarriugarte
Javier Mar
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2015
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-015-1700-4

Other articles of this Issue 1/2015

BMC Cancer 1/2015 Go to the issue

Research article

Transient elevation of glycolysis confers radio-resistance by facilitating DNA repair in cells

Research article

Outcome of vulvar reconstruction in patients with advanced and recurrent vulvar malignancies

Study protocol

Study of Preoperative Radiotherapy for Sarcomas of the Extremities with Intensity-Modulation, Image-Guidance and Small Safety-margins (PREMISS)

Research article

Gastric cancer-associated enhancement of von Willebrand factor is regulated by vascular endothelial growth factor and related to disease severity

Research article

MicroRNA-223 is a novel negative regulator of HSP90B1 in CLL

Research article

Evaluation of the efficacy and safety of lanreotide in combination with targeted therapies in patients with neuroendocrine tumours in clinical practice: a retrospective cross-sectional analysis
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits