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1 Center for Health Studies, Group Health Cooperative, Seattle, Washington; 2 Department of Epidemiology, University of Washington, Seattle, Washington; and 3 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
The objective of our study was to evaluate organized breast cancer screening implementation by measuring the association between screening program enrollment and late-stage disease. Our setting was a health plan using mailed mammography reminders to women ages 
40. We conducted yearly cross-sectional summaries of mammography experience and late-stage (regional or distant Surveillance Epidemiology and End Results Reporting (SEER) stage) breast cancer occurrence for all of the health-plan women ages 40 (1986–1998). We estimated the odds of late-stage breast cancer among health-plan and surrounding community women because it was too early to compare changes in mortality. We also estimated the odds of late-stage disease (1995–1998) associated with program enrollment and mammography screening among health-plan women. We found that mammography-within-two-years increased within the health plan from 25.9% to 51.2% among women ages 40–49 and from 32.9% to 74.7% among women ages 50. Health-plan late-stage rates were lower than those in the surrounding community [ages 40–49: odds ratio (OR), 0.87; 95% confidence interval (CI), 0.77–0.99; ages 50–79: OR, 0.86; 95% CI, 0.80–0.92] and declined parallel to the community. Among health-plan cancer cases, women ages 43 who were enrolled in the screening program and who had at least one program mammogram were less likely to have late-stage disease compared with the women not enrolled in the program (OR, 0.31; 95% CI, 0.16–0.61) but the odds of late-stage was also reduced among program-enrolled women not receiving program mammograms (OR, 0.45; 95% CI, 0.21–0.95). We concluded that enrollment in organized screening is associated with increased likelihood of mammography and reduced odds of late-stage breast cancer. Addressing the concerns of un-enrolled women and those without mammograms offers an opportunity for further late-stage disease reduction.
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