Background: Breast cancer screening mammography is widespread in industrialised countries within the\nframework of public health program or opportunist form. Only few data exist on the comparison of effectiveness\nbetween organised and opportunistic screening. The aim of this study is to compare organised and opportunistic\nscreening using population-based data from the Fribourg cancer registry, Switzerland.\nMethods: We included all first primary breast adenocarcinoma diagnosed between 2006 and 2014 in women aged\n50â??69 years resident in the canton of Fribourg. We considered only breast cancer discovered by mammography\nscreening. We compared patients, tumour characteristics and treatment modalities between breast cancer detected\nby the organised screening program versus opportunistic screening using logistic regression.\nResults: Out of 989 patients diagnosed with breast cancer, 402 (40.6%) were diagnosed by organised and 205 (20.\n7%) by opportunistic screening. Women with breast cancer detected within the screening program were more\nlikely to be from rural areas (P = 0.035) and lived less frequently in high favoured regions (P = 0.020). They presented\nmore frequently in situ than invasive cancer (P = 0.022). For patients with invasive breast cancer, those detected by\nthe program were less likely to undergo mastectomy (P = 0.06) and consequently, they were more likely to undergo\nradiation therapy (P = 0.003). Adjustment for area of residence and financial context of the region did not modify\nthe results presented.\nConclusions: The present study reports an increased rate of detection of carcinoma in situ in organised screening\nprogram as compared to opportunistic screening mammographies, an indirect evidence of a higher radiologic\nsensitivity. Furthermore, the results show a trend towards more mastectomies among patients with breast cancer\ndiscovered after opportunistic than after organized mammography screening, reflecting lower treatment burden.\nThose results were independent of socio-economic factors which differed across screening groups.
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