Journal of Medical Screening > Volume 16, Number 3 > Pp. 131-139

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Original Articles

Comparing interval breast cancer rates in Norway and North Carolina: results and challenges

Solveig Hofvind, Researcher  , Department of Screening Based-research, The Cancer Registry of Norway, 0304 Oslo, Norway

Bonnie C Yankaskas, Professor , Department of Radiology, University of North Carolina at Chapel Hill, 27599, USA

Jean-Luc Bulliard, Epidemiologist , Cancer Epidemiology Unit, University Institute of Social and Preventive Medicine, Lausanne, Switzerland

Carrie N Klabunde, Epidemiologist , Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA

Jacques Fracheboud, Senior Researcher , Department of Public Health, NETB, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

Correspondence to: Solveig Hofvind PhD, Department of Screening Based-research, The Cancer Registry of Norway, NO-0310 Oslo, Norway; solveig.hofvind{at}kreftregisteret.no

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Objective To compare interval breast cancer rates (ICR) between a biennial organized screening programme in Norway and annual opportunistic screening in North Carolina (NC) for different conceptualizations of interval cancer.

Setting Two regions with different screening practices and performance.

Methods 620,145 subsequent screens (1996–2002) performed in women aged 50–69 and 1280 interval cancers were analysed. Various definitions and quantification methods for interval cancers were compared.

Results ICR for one year follow-up were lower in Norway compared with NC both when the rate was based on all screens (0.54 versus 1.29 per 1000 screens), negative final assessments (0.54 versus 1.29 per 1000 screens), and negative screening assessments (0.53 versus 1.28 per 1000 screens). The rate of ductal carcinoma in situ was significantly lower in Norway than in NC for cases diagnosed in both the first and second year after screening. The distributions of histopathological tumour size and lymph node involvement in invasive cases did not differ between the two regions for interval cancers diagnosed during the first year after screening. In contrast, in the second year after screening, tumour characteristics remained stable in Norway but became prognostically more favorable in NC.

Conclusion Even when applying a common set of definitions of interval cancer, the ICR was lower in Norway than in NC. Different definitions of interval cancer did not influence the ICR within Norway or NC. Organization of screening and screening performance might be major contributors to the differences in ICR between Norway and NC.

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