Presentation (CTI)

OBJECTIVES: This study investigates the impact of detection modality - screening mammography (SCR) versus diagnostic mammography (DIG) - on care delivery, timing and survival in breast cancer patients in the Czech Republic.
METHODS: We analyzed linked data from the Czech National Oncology Registry and health insurance claims for women diagnosed with primary breast cancer between 2017 and 2022. Patients were stratified by detection method (SCR vs. DIG). Outcomes included stage at diagnosis, time to first-line therapy, centralization of care to specialized cancer centers and overall survival. We performed a series of Cox proportional hazards models stratified by clinical stage (I-III) to assess the association between surgery delay and overall survival, adjusting for age, treatment centralization, diagnosis year, and neoadjuvant therapy.
RESULTS: Among 33,431 patients, 55.7% were diagnosed via SCR and 44.3% via DIG. SCR patients were older (median age 66 vs. 58 years) and more frequently diagnosed at early stages (Stage I: 64.2% vs. 30.2%). DIG patients had a higher proportion of advanced-stage disease and were more likely to receive systemic therapy (e.g., Stage II: 49.3% DIG vs. 27.9% SCR). Time to treatment was shorter in the DIG group across all treatment modalities, with median time ranging from 37 days (DIG) vs. 47 days (SCR). Centralization of care increased over time, particularly for advanced stages, but regional disparities remained. The association between surgical delay and survival was not uniform. In Stage II DIG patients, surgery initiated more than two months after mammography was associated with worse survival.
CONCLUSIONS: Detection modality significantly influences the clinical trajectory of breast cancer patients. While DIG patients benefit from faster treatment initiation, they face more aggressive disease, lower surgical rate, and poorer outcomes. These findings underscore the critical role of screening in early detection.