The influence of breast screening on breast cancer incidence in England - observational study based on cancer registries and bulletins of the NHS Breast Screening Programme

Sep 21, 2026

Uploaded by Oliver

Assessment of breast cancer overdiagnosis linked to the National Health Service Breast Screening Programme (NHSBSP) in England is conducted using two independent approaches. First, cancers among women eligible for screening but not attending were estimated for 1995–2019 and extrapolated to all women. Second, expected cancers for 1988–2019 were derived from incidence-rate ratios between age groups in 1971–1985. Results report substantial excess overdiagnosis and consistent estimates across methods, indicating the NHSBSP is associated with a considerable overdiagnosis burden.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Background

Methods

Overview

The NHS breast screening programmes

Data sources

Results

Conclusion

European Journal of Public Health, Vol. 34, No. 4, 812–817 \# The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ([https://creativecommons](https://creativecommons). org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [journals.permissions@oup.com](journals.permissions@oup.com) [https://doi.org/10.1093/eurpub/ckae069](https://doi.org/10.1093/eurpub/ckae069) Advance Access published on 30 April 2024 The influence of breast screening on breast cancer incidence in England: observational study based on cancer registries and bulletins of the NHS Breast Screening Programme Philippe Autier , Romain Ould Ammar , Maria Bota International Prevention Research Institute (iPRI), Lyon, France Correspondence: Philippe Autier, International Prevention Research Institute (iPRI), 18 Chemin des Cuers, 69570 Dardilly, France. Tel: þ33 472 171 183, Fax: þ33 472 171 199, e-mail: [philippe.autier@i-pri.org](philippe.autier@i-pri.org) Background: To assess the amount of breast cancer overdiagnosis associated with the National Health Service Breast Screening Programme (NHSBSP) that started in 1988 in England. Methods: First, numbers of breast cancersin women eligible for breast screening not attending screening were estimated for the period 1995–2019, which were extrapolated to all women. A second method was based on ratios of incidence rates of breast cancers in women aged 50–69 to women aged 70 years or more in 1971–1985. The ratio was used for estimating expected numbers of cancers in 1988–2019, and 1995–2019. Results: From 1995 to 2019, 506,607 non-invasive and invasive breast cancers were diagnosed among women aged 50–64 years (1995–2001) and 50–70 years (2002–2019) . A first method estimated that 95,297 cancers were in excess to the number of cancers that would be expected had the NHSBSP not existed. 42,567 screen-detected non-invasive and micro-invasive cancers represented 45.8% of the total excess cancer. 18.8% of all cancers diagnosed among women invited to screening, 25.1% of cancers found in women attending screening, and 35.1% of cancers detected by screening would represent overdiagnosis. A second method estimated that, 18.0% of all cancers diagnosed in 1988–2019, and 18.2% of all cancers diagnosed in 1995–2019 among women invited to screening would represent overdiagnosis. Conclusion: The two independent methods obtained similar estimates of overdiagnosis. The NHS Breast Screening Programme in England is associated with substantial amount of overdiagnosis. Introduction F ollowingScreeningthePrFoogrreastmRmeepso(rt, 1 tNHShBeSNP)atiwoansalsHtaealtrtedhiSnerviEncgelaBrndeaistn 1988. An undesirable consequence of cancer screening is overdiagnosis, which is the screen-detection of cancers that would not progress into symptomatic cancers during lifetime.2–4 Overdiagnosed breast cancers mainly consist of ductal in situ cancer and small, localized invasive cancers. However, the magnitude of breast cancer overdiagnosis is difficult to assess because one cannot distinguish screen-detected cancers that would progress or not progress into symptomatic cancers. The study objective was to assess the amount of overdiagnosis associated with the NHSBSP in England using two independent methods that used activity and cancer statistics reported by the NHSBSP, as well as cancers statistics from cancer registries. Methods Overview A first method used the annual Bulletins entitled “Breast Screening Programme, England” published from 1995 to 2019 and cancer registries for estimating the incidence rates of cancers in women in age groups invited to screening but who did not attend screening. Then, assuming that these inciden

FAQs

What question does the study address about breast screening in England?

It evaluates the amount of breast cancer overdiagnosis associated with the NHS Breast Screening Programme (NHSBSP) in England.

How are the expected numbers of cancers estimated in the study?

One approach estimates incidence among women eligible but not attending screening and extrapolates to all women; the other uses incidence-rate ratios between age groups from 1971–1985 to project expected cancers for later periods.

What do the results indicate about overdiagnosis?

Both independent methods yield similar estimates, and the NHSBSP is associated with a substantial amount of overdiagnosis.

Sep 21, 2026

Uploaded by Oliver