Early screening outcomes among non-immigrants and immigrants targeted by BreastScreen Norway, 2010-2019.

AIMS: This study aimed to analyse results on early screening outcomes, including recall and cancer rates, and histopathological tumour characteristics among non-immigrants and immigrants invited to BreastScreen Norway. METHODS: We included information about 2, 763,230 invitations and 2,087,222 screening examinations from 805,543 women aged 50-69 years who were invited to BreastScreen Norway between 2010 and 2019. Women were stratified into three groups based on their birth country: non-immigrants, immigrants born in Western countries and immigrants born in non-Western countries. Age-adjusted regression models were used to analyse early screening outcomes. A random intercept effect was included in models where women underwent several screening examinations. RESULTS: The overall attendance was 77.5% for non-immigrants, 68% for immigrants from Western countries and 51.5% for immigrants from non-Western countries. The rate of screen-detected cancers was 5.9/1000 screening examinations for non-immigrants, 6.3/1000 for immigrants from Western countries and 5.1/1000 for immigrants from non-Western countries. Adjusted for age, the rate did not differ statistically between the groups (p=0.091). The interval cancer rate was 1.7/1000 screening examinations for non-immigrants, 2.4/1000 for immigrants from Western countries and 1.6/1000 for non-Western countries (p<0.001). Histological grade was less favourable for screen-detected cancers, and subtype was less favourable for interval cancers among immigrants from non-Western countries versus non-immigrants. CONCLUSIONS: There were no differences in age-adjusted rate of screen-detected cancer among non-immigrants and immigrants from Western countries or non-Western countries among women attending BreastScreen Norway between 2010 and 2019. Small but clinically relevant differences in histopathological tumour characteristics were observed between the three groups.

Effect of invitation letter in language of origin on screening attendance: randomised controlled trial in BreastScreen Norway.

OBJECTIVE: To explore attendance at organised mammographic screening among immigrant groups that received an invitation letter and information leaflet (invitation) in their language of origin and Norwegian compared with Norwegian only. DESIGN: Randomised controlled trial. SETTING: Population based screening programme for breast cancer in Norway (BreastScreen Norway), which invites women aged 50-69 to two-view mammographic screening biennially. PARTICIPANTS: All women invited to BreastScreen Norway in the study period April 2021 to June 2022 whose language of origin was Arabic (women born in Algeria, Egypt, Lebanon, Iraq, Palestine, Sudan, Syria, Tunisia, or Morocco), English (women born in the Philippines), Polish (women born in Poland), Somali (women born in Somalia), or Urdu (women born in Pakistan) (n=11 347). INTERVENTION: The study group received an invitation to screening in their language of origin and in Norwegian, whereas the control group received an invitation in Norwegian only during the study period. MAIN OUTCOME MEASURE: Attendance at BreastScreen Norway during the study period. RESULTS: Overall attendance was 46.5% (2642/5683) in the study group and 47.4% (2682/5664) in the control group. No statistical differences in attendance were observed after stratification by language of invitation, age at invitation, or years since immigration. CONCLUSIONS: No difference in attendance was observed between immigrant women invited to BreastScreen Norway in their language of origin and in Norwegian compared with Norwegian only. Several barriers to cancer screening may exist among immigrants, and translating the invitation is probably only a part of a complex explanation. TRIAL REGISTRATION: NCT04672265. CLINICALTRIALS: gov NCT04672265.

Early performance measures following regular versus irregular screening attendance in the population-based screening program for breast cancer in Norway.

OBJECTIVE: Irregular attendance in breast cancer screening has been associated with higher breast cancer mortality compared to regular attendance. Early performance measures of a screening program following regular versus irregular screening attendance have been less studied. We aimed to investigate early performance measures following regular versus irregular screening attendance. METHODS: We used information from 3,302,396 screening examinations from the Cancer Registry of Norway. Examinations were classified as regular or irregular. Regular was defined as an examination 2 years ± 6 months after the prior examination, and irregular examination >2 years and 6 months after prior examination. Performance measures included recall, biopsy, screen-detected and interval cancer, positive predictive values, and histopathological tumor characteristics. RESULTS: Recall rate was 2.4% (72,429/3,070,068) for regular and 3.5% (8217/232,328) for irregular examinations. The biopsy rate was 1.0% (29,197/3,070,068) for regular and 1.7% (3825/232,328) for irregular examinations, while the rate of screen-detected cancers 0.51% (15,664/3,070,068) versus 0.86% (2003/232,328), respectively. The adjusted odds ratio was 1.53 (95% CI: 1.49-1.56) for recall, 1.73 (95% CI: 1.68-1.80) for biopsy, and 1.68 (95% CI: 1.60-1.76) for screen-detected cancer after irregular examinations compared to regular examinations. The proportion of lymph node-positive tumors was 20.1% (2553/12,719) for regular and 25.6% (426/1662) for irregular examinations. CONCLUSION: Irregular attendance was linked to higher rates of recall, needle biopsies, and cancer detection. Cancers detected after irregular examinations had less favorable histopathological tumor characteristics compared to cancers detected after regular examinations. Women should be encouraged to attend screening when invited to avoid delays in diagnosis.

Participation and cancer detection after reminders versus ordinary invitations in BreastScreen Norway.

OBJECTIVES: To compare attendance, recall and cancer detection as well as histopathological tumor characteristics among women attending BreastScreen Norway after a reminder versus an ordinary invitation. SETTING: This study was conducted on data from a population-based screening program inviting women aged 50-69 to biennial two-view mammography. METHODS: We used de-identified data from 883,020 women invited to BreastScreen Norway, 2004-2020, to analyze invitations, participation, recalls, biopsies, cancer detection, and histopathological tumor characteristics. All results were stratified by reminders and ordinary invitations. Early screening outcomes after reminders versus ordinary invitations were compared using bivariate tests and multivariable logistic regression. RESULTS: Reminders increased overall participation rate by 5.0%. The recall rate was 4.3% for reminded women and 3.3% for the ordinary invited. For reminded women, the rate of screen-detected cancer was 7.3 per 1000 screening examinations compared to 5.8 per 1000 for ordinary attenders. The interval cancer rates were 1.9 and 1.7 per 1000 for reminded and ordinary invited women, respectively. Median tumor diameter was 14 mm (interquartile range (IQR): 10-16) for screen-detected cancers (SDC) among reminded women and 13 mm (IQR: 10-16) for ordinary invited. A higher percentage of histological grade III cancers was observed among the reminded: 25.2% versus 21.7% for the ordinary invited. We also found a higher proportion of lymph node positive cases in those reminded: 23.6% versus 20.9%. CONCLUSIONS: Postponing screening examinations affects early screening outcomes, including cancer detection and histopathological tumor characteristics. Women should be encouraged to attend screening at regularly intervals to avoid delays in diagnosis.