Abstract
Relative survival and disease-specific survival are two statistics that measure net
survival from a cancer diagnosis, excluding other causes of death. In most cases,
these two rates are comparable. However, in some cancer types for which cancer screening
is performed, relative survival is often greater than disease-specific survival. This
divergence has been attributed to mechanisms such as the “healthy user effect” and
overdiagnosis of indolent tumors detected by screening. Using relative survival rate
as a marker of these mechanisms, we examined the association of breast cancer screening
with relative survival rates for women diagnosed with early-stage breast cancer. In
population-based data from the National Cancer Institute’s Surveillance, Epidemiology
and End Results registry, we examined relative survival rates in women diagnosed with
stage I breast cancer or ductal carcinoma in situ who were in highly screened vs less-highly
screened groups, based on time period, age group, and insurance status. In this analysis,
relative survival rates for early-stage breast cancer were higher than disease-specific
survival, even exceeding 100% in populations experiencing higher rates of screening
(ie, women diagnosed during the era of widespread uptake of mammography, age older
than 40 years, and women with health insurance coverage). The favorable outcomes observed
in screen-detected breast cancers are at least in part attributable to the healthy
user effect and overdiagnosis of indolent tumors. Therefore, survival rates may not
accurately reflect the effectiveness of cancer screening. These findings have implications
for counseling of patients and future clinical studies of active monitoring approaches
in breast cancer.
Abbreviations and Acronyms:
DCIS (ductal carcinoma in situ), SEER (Surveillance, Epidemiology and End Results Program)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 03, 2022
Footnotes
Grant Support: This work was supported by the National Cancer Institute Cancer Center Support Grant (P30 CA008748), the National Institutes of Health (grant numbers T32 CA009685 to A.R.M, K08 DE024774 and R01 DE027738 to L.G.T.M), the Frederick Adler Chair Fund, and Jamie Flowers Fund (to L.G.T.M)
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Crown Copyright © 2022 Published by Elsevier Inc on behalf of Mayo Foundation for Medical Education and Research. All rights reserved.
