Effects of screening and systemic adjuvant therapy on ER-Specific US breast cancer mortality

Diego Munoz, Aimee M. Near, Nicolien T. Van Ravesteyn, Sandra J. Lee, Clyde B. Schechter, Oguzhan Alagoz, Donald A. Berry, Elizabeth S. Burnside, Yaojen Chang, Gary Chisholm, Harry J. De Koning, Mehmet Ali Ergun, Eveline A.M. Heijnsdijk, Hui Huang, Natasha K. Stout, Brian L. Sprague, Amy Trentham-Dietz, Jeanne S. Mandelblatt, Sylvia K. Plevritis

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110 Scopus citations


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 screendetected 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 languageEnglish (US)
Article numberdju289
JournalJournal of the National Cancer Institute
Issue number11
StatePublished - Nov 1 2014

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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