Estimating mean sojourn time and screening test sensitivity in breast cancer mammography screening:: new results

Objective: To assess if new screening techniques, increased use of hormone replacement therapy, or the transition from breast cancer screening trials to large scale screening programmes may influence the average time in preclinical screening detectable phase (mean sojourn time [MST]) or screening test sensitivity (STS). Setting: Screening and interval data for 395,188 women participating in the Norwegian Breast Cancer Screening Programme (NBCSP). Methods: Weighted non-linear least-square regression estimates using a tree step Markov chain model, and a sensitivity analysis of the possible impact by opportunistic screening between ordinary breast cancer screening rounds. Results: MST was estimated to 6.1 (95% confidence interval [CI] 5.1-7.0) years for women aged 50-59 years, and 7.9 (95% CI 6.0-7.9) years for those aged 60-69 years. Correspondingly, STS was estimated to 58% (95% CI 52-64%) and 73% (67-78%), respectively. Simulations revealed that opportunistic screening may give a moderate estimation bias towards higher MST and lower STS. Assuming a probable 21% higher background incidence, due to increased hormone replacement therapy use, MST estimates decreased to 3.9 and 5.0 years for the two age groups, and STS increased to 75 and 85%. Conclusions: The new estimates indicate that screening detectable phase is longer than that found in. previous mammography trials/programmes, but also that the sensitivity of the screening test is lower. Overall, the NBCSP defects more cancer cases than most previous trials/programmes.