Optimization of breast cancer screening: informed decisions on benefits and harms

This thesis demonstrated an association between less regular participation in breastcancer screening and significantly lower odds of cancer detection as well as higher odds ofadvanced stage cancer detection. Regular screening is key to detecting breast cancer at anearly stage. However, whereas women of both high and low SES had high non-participationrates in organized screening, it was mostly women of high SES who participated inopportunistic screening. To improve the efficiency of organized screening, we needto evaluate strategies that can reach non-participating women and we must improverecruitment efforts for women of low SES who may face barriers to screening. It was alsoshown that overdiagnosis was more related to DCIS than to invasive breast cancer, and thatestimates of invasive breast cancer overdiagnosis depend on the follow-up time and age ofscreening. Moving forward, we must ensure a sufficient follow-up time of at least 10 yearsto obtain unbiased overdiagnosis estimates