Thirty years of population-based breast cancer screening in Iceland: a comparison of quality indicators and tumour characteristics between women aged 40–49 and 50–69 years

Background and purpose: Organised mammography screening reduces breast cancer mortality by 30–40% in women aged 50–69. Despite limited evidence for women aged 40–49, screening guidelines are trending toward younger ages. Iceland has offered biennial screening to women aged 40–69 since 1987. This study compares screening quality indicators and tumour characteristics between women aged 40–49 and 50–69 from 1990 to 2020. Patient/material and methods: Screening-related data were obtained from the Icelandic Breast Cancer Screening Program, and breast cancer diagnoses and tumour characteristics were sourced from the Icelandic Cancer Registry. Results: In total, 84,677 women aged 40–69 years attended 455,532 organised screening sessions in Iceland over a 30-year period. Women aged 40–49 years demonstrated higher recall rates (4.9% vs. 3.5%) and lower participation rates (60.7% vs. 61.5%), lower breast cancer detection rates (2.1 vs. 6.0/1,000), and lower episode sensitivity (54.8% vs. 70.5%), compared to those aged 50–69 years. Among screen-detected cases, women aged 40–49 years exhibited a higher proportion of tumours larger than 20 mm (29.7% vs. 21.7%), more lymph node positivity (41.2% vs. 28.2%) and higher human epidermal growth factor receptor 2 (HER2) positivity (18.6% vs. 11.8%), compared to those aged 50–69 years. Interpretation: The disparity in breast cancer screening performances between the age groups may reflect unmodifiable factors in younger women. The presence of advanced tumour characteristics among women aged 40–49 years who attended screening indicates the importance of early detection for improving prognosis.