Mammography screening reduced lifetime loss of employment duration and productivity for women with breast cancer: Real‐world evidence of societal impacts

The objective of this study is to evaluate the personal and societal impacts of mammography screening by estimating the life expectancy (LE), LE loss, lifetime employment duration (LED), LED loss, lifetime productivity (LP), and LP loss of women with breast cancer (BC). We recruited 113,169 women with BC diagnosis (2002-2017) from the Taiwan Cancer Registry, following survival until 2018. The monthly employment-population ratio (EMRATIO) and insured salary were abstracted from the National Health Insurance (NHI) until 2017. Lifetime survivals were extrapolated using relative survival with age-, sex-, and calendar-year-matched referents from vital statistics through a rolling-over algorithm, which were used in hazard models estimating LED and LP, with losses calculated by comparing the BC cohort to matched referents and relative loss percentages. We summarized the overall losses of LED and LP weighted by stage shifts between those who received screening versus those who did non-screening. We found no LED or LP losses for stages 0-I. LED losses for stages II-IV were 0.8, 2.3, and 5.1 years, respectively, with relative losses of LP being 9.4%, 30.2%, and 69.0%, respectively. Younger women faced more significant losses, with those aged 18-39 experiencing at least triple LED loss in stages III and IV compared to stage II. Mammography screening led to overall reductions of 2.9 years in LE, 0.6 years in LED, and 7.1% in LP, equivalent to a savings of US$ 7169. The mammography screening program in Taiwan improved the health and productivity of the population, especially among younger women.