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Decreased Breast Cancer Size, Stage and Mortality in Rhode Island: An Example of a Well-Screened Population

Natalie G Coburn1, Maureen A Chung1, John Fulton2, Blake Cady1
1Rhode Island Hospital, Brown University, Providence, RI;2Rhode Island Department of Health, Providence, RI

OBJECTIVE:
To determine the impact of a high mammographic screening rate on breast cancer presentation and outcome
Design:
Population cohort study
Setting:
State cancer registry
Patients:
All incident breast cancers diagnosed in female residents from 1987 to 2001
Main Outcomes Measures:
Mammography rates, in situ (DCIS) and invasive breast cancer incidence, tumor size, extent of nodal metastases, rate of breast conservation surgery (BCS) and mortality
Results:
The rate of mammography in all age groups increased, with 84% of all women reporting a mammogram within the prior two years in 1999-2001 (p<0.001). There were 11,301 cases of breast cancer diagnosed from 1987-2001. There was a 129% increase in the incidence of DCIS (p<0.01) with no increase in the incidence of invasive disease. The mean tumor size of invasive cancer decreased from 2.5±1.9 cm to 2.0±1.7 cm (p<0.01) with a decrease in the extent of nodal metastases and significantly fewer Stage III and IV cancers reported in the latter years of the study (p<0.05). There has been an increase in the rate of BCS in women 50-64 years with Stage 0, I, and II tumors and in women age 65 and older with Stage I cancers. Breast cancer mortality decreased 25% from 38.0/100,000 to 28.4/100,000 in 1987-89 and 1998-2000, respectively (p<0.001).
Conclusions:
High mammography rates have resulted in smaller breast cancers permitting increased breast conservation surgery and a decrease in mortality.

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