What are the associations of screening and adjuvant treatment with reductions in US breast cancer mortality rates by molecular subtype?
In this study of 6 simulation models that projected US breast cancer mortality trends for women aged 30 to 79 years, advances in treatment, such as use of newer adjuvant therapies, compared with screening advances were associated with greater estimated reductions in overall breast cancer mortality from 2000 to 2012, although the associations varied by breast cancer molecular subtype.
Simulation modeling estimated that advances in treatment were associated with greater decreases in breast cancer mortality rates than advances in screening, although these associations varied by molecular subtype.
Given recent advances in screening mammography and adjuvant therapy (treatment), quantifying their separate and combined effects on US breast cancer mortality reductions by molecular subtype could guide future decisions to reduce disease burden.
To evaluate the contributions associated with screening and treatment to breast cancer mortality reductions by molecular subtype based on estrogen-receptor (ER) and human epidermal growth factor receptor 2 (ERBB2, formerly HER2 or HER2/neu).
Design, Setting, and Participants
Six Cancer Intervention and Surveillance Network (CISNET) models simulated US breast cancer mortality from 2000 to 2012 using national data on plain-film and digital mammography patterns and performance, dissemination and efficacy of ER/ERBB2-specific treatment, and competing mortality. Multiple US birth cohorts were simulated.
Screening mammography and treatment.
Main Outcomes and Measures
The models compared age-adjusted, overall, and ER/ERBB2-specific breast cancer mortality rates from 2000 to 2012 for women aged 30 to 79 years relative to the estimated mortality rate in the absence of screening and treatment (baseline rate); mortality reductions were apportioned to screening and treatment.
In 2000, the estimated reduction in overall breast cancer mortality rate was 37% (model range, 27%-42%) relative to the estimated baseline rate in 2000 of 64 deaths (model range, 56-73) per 100 000 women: 44% (model range, 35%-60%) of this reduction was associated with screening and 56% (model range, 40%-65%) with treatment. In 2012, the estimated reduction in overall breast cancer mortality rate was 49% (model range, 39%-58%) relative to the estimated baseline rate in 2012 of 63 deaths (model range, 54-73) per 100 000 women: 37% (model range, 26%-51%) of this reduction was associated with screening and 63% (model range, 49%-74%) with treatment. Of the 63% associated with treatment, 31% (model range, 22%-37%) was associated with chemotherapy, 27% (model range, 18%-36%) with hormone therapy, and 4% (model range, 1%-6%) with trastuzumab. The estimated relative contributions associated with screening vs treatment varied by molecular subtype: for ER+/ERBB2−, 36% (model range, 24%-50%) vs 64% (model range, 50%-76%); for ER+/ERBB2+, 31% (model range, 23%-41%) vs 69% (model range, 59%-77%); for ER−/ERBB2+, 40% (model range, 34%-47%) vs 60% (model range, 53%-66%); and for ER−/ERBB2−, 48% (model range, 38%-57%) vs 52% (model range, 44%-62%).
Conclusions and Relevance
In this simulation modeling study that projected trends in breast cancer mortality rates among US women, decreases in overall breast cancer mortality from 2000 to 2012 were associated with advances in screening and in adjuvant therapy, although the associations varied by breast cancer molecular subtype.
Plevritis SK, Munoz D, Kurian AW, Stout NK, Alagoz O, Near AM, Lee SJ, van den Broek JJ, Huang X, Schechter CB, Sprague BL, Song J, de Koning HJ, Trentham-Dietz A, van Ravesteyn NT, Gangnon R, Chandler Y, Li Y, Xu C, Ergun MA, Huang H, Berry DA, Mandelblatt JS. Association of Screening and Treatment With Breast Cancer Mortality by Molecular Subtype in US Women, 2000-2012. JAMA. 2018;319(2):154–164. doi:10.1001/jama.2017.19130