Survival Benefits and Less Intensive Treatment for Women with Early-Stage Breast Cancer Diagnosed While Participating in Population-Based Screening

Q: What groups were compared in this study?

The study compared active screeners (screen-detected and interval cancers) with not recently screened women who were either never screened or last screened more than 27 months before diagnosis.

Q: How long was the follow-up and how were outcomes obtained?

Follow-up data were collected for 766 women (97.1%) with a median follow-up of 11.6 years. Mortality and subsequent cancer diagnoses were derived from linkage with the Victorian Cancer Registry.

Q: What survival benefits were reported for active screeners?

Ten-year breast cancer-specific survival was higher for active screeners (95.4%) than not recently screened (86.4%), and ten-year overall survival was also superior (90.6% vs 82.5%).

Q: Were the findings affected by overdiagnosis or lead time bias?

Sensitivity analyses adjusting for estimated overdiagnosis and lead time bias still showed a persistent survival benefit for active screeners.

Sep 23, 2026

Uploaded by Kurz

Study evaluating women with early-stage breast cancer (ESBC) diagnosed during population-based breast screening compares active screeners (including screen-detected and interval cancers) with not recently screened women. Follow-up data were obtained for 766 of 789 participants with 11.6 years median follow-up, linking outcomes to the Victorian Cancer Registry. Breast cancer-specific and overall survival favored active screeners and remained significant after sensitivity adjustments for overdiagnosis and lead-time bias.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Methods

Results

Discussion

Methods

Cohort and Classification

Ann Surg Oncol (2025) 32:8100–8110 [https://doi.org/10.1245/s10434-025-17845-1](https://doi.org/10.1245/s10434-025-17845-1) ORIGINAL ARTICLE – BREAST ONCOLOGY Survival Benefits and Less Intensive Treatment for Women with Early‑Stage Breast Cancer Diagnosed While Participating in Population‑Based Screening Melissa Edwards, BSc, MBChB, PhD, FRACS1,2,3, Kenneth Elder, BEng, MSc, MPhil, BMBS, MRCS2,4, Allison Rose, MBBS, FRANZCR2, Elizabeth Tan, MBBS, FRACS2,5, Allan Park, MN2, Carolyn Nickson, BA, Grad Dip, PhD5,6, and G. Bruce Mann, MBBS, PhD, FRACS1,2,5,6 1Peter MacCallum Cancer Centre, Melbourne, Australia; 2The Royal Melbourne Hospital, Melbourne, Australia; 3The University of Auckland, Auckland, New Zealand; 4Western General Hospital, Edinburgh, UK; 5University of Melbourne, Melbourne, Australia; 6The Daffodil Centre, a joint venture between the University of Sydney & Cancer Council NSW, Sydney, Australia ABSTRACT Background. The authors previously reported that within a patient cohort from Victoria, Australia, women who had early-stage breast cancer (ESBC) diagnosed while participating in screening [active screeners (AS), comprising both screen-detected and interval cancers] receive less intensive treatment than those not recently screened (NRS) . This study reports mortality and subsequent cancer events for that cohort. Methods. Follow-up data were collected for 766 (97.1%) of the 789 women in the original cohort (612 [79.9%] AS and 154 [20.1%] NRS), with a median follow-up time of 11.6 years (interquartile range [IQR], 9.8–13.8 years) . Mortality and subsequent cancer diagnosis data were derived from linkage with the Victorian Cancer Registry. Breast cancer-specific survival (BCSS) and overall survival (OS) were compared between groups, with sensitivity analyses for potential overdiagnosis and lead time bias. Results. The 10-years BCSS was 95.4%(95% confidence interval [CI], 93.2–96. 8%) for AS versus 86.4%(95% CI 79.7–91.0%) for NRS (hazard ratio [HR], 0.28; 95% CI Carolyn Nickson and G. Bruce Mann have contributed equally asa Joint senior authors. © The Author(s) 2025 First Received: 24 April 2025 Accepted: 23 June 2025 Published online: 25 July 2025 G. B. Mann, MBBS, PhD, FRACS[e-mail: Bruce.Mann@mh.org.au](e-mail: Bruce.Mann@mh.org.au) 0.17–0.48; p < 0.001) . A survival benefit persisted after adjustment for estimated overdiagnosis (HR 0.38; 95% CI 0.21–0.66; p = 0.001) and lead time bias (HR 0.33; 95% CI 0.19–0.58; p < 0.001) . The 10-year OS also was superior for AS, at 90.6%(95% CI 87.9–92.7%) compared with 82.5%(95% CI 75.4–87.8%) for NRS (HR 0.54; 95% CI 0.36–0.79; p = 0.002) . Discussion. Patients who have ESBC diagnosed while participating in screening experience improved BCSS and OS while receiving less intensive treatment. These findings are robust to adjustment for potential overdiagnosis and lead time bias. As treatment for ESBC becomes more tailored, with emerging opportunities for reduced treatment intensity, the benefits of screening are likely to improve further. In high-income settings, reduced breast cancer mortality in recent decades has been attributed to the introduction of population-based mammographic screening programs combined with advancements in adjuvant systemic therapies. 1 The principle of screening is to advance the diagnosis of breast cancer so that prognosis may be improved by earlier intervention. The seminal trials of mammographic screening in the 1970s and 1980s showed an overall 20% reduction in breast cancer death among invited women,2–4 with the greatest value demonstrated in the 50–69-years age group.5–7 More contemporary trial updates and observational analyses have continued to show a significant breast cancer-specific survival (BCSS) benefit from participation in screening.5,7–9 Overdiagnosis is the detection of histologically confirmed breast cancer through screening that would never have been diagnosed clinically during the lifetime

FAQs

What groups were compared in this study?

The study compared active screeners (screen-detected and interval cancers) with not recently screened women who were either never screened or last screened more than 27 months before diagnosis.

How long was the follow-up and how were outcomes obtained?

Follow-up data were collected for 766 women (97.1%) with a median follow-up of 11.6 years. Mortality and subsequent cancer diagnoses were derived from linkage with the Victorian Cancer Registry.

What survival benefits were reported for active screeners?

Ten-year breast cancer-specific survival was higher for active screeners (95.4%) than not recently screened (86.4%), and ten-year overall survival was also superior (90.6% vs 82.5%).

Were the findings affected by overdiagnosis or lead time bias?

Sensitivity analyses adjusting for estimated overdiagnosis and lead time bias still showed a persistent survival benefit for active screeners.

Sep 23, 2026

Uploaded by Kurz