Breast screening of the West Midlands women of 50-64 years started in 1988. Reductions in breast cancer deaths induced by mammography screening should be preceded by reductions in the incidence of advanced breast cancer. We estimated incidence trends in advanced breast cancer from 1989 to 2004. We extracted numbers of cases of breast cancer found in the West Midlands women aged 50-64 years from the Cancer Incidence in Five Continent database. We used published data for estimating the incidence of advanced breast cancer. Then, annual percent changes in incidence rates were computed using join point regression. The incidence rates of lymph node-positive breast cancer increased from 1989 to 1992. In 1993-1995, they decreased below the prescreening level, but from 1996 to 2000, they returned to prescreening levels and then stabilized. From 1989 to 2004, annual percent changes (95% confidence interval) were 2.2% (1.1-3.2%) for node-negative cancers and -0.7% (-1.9 to 0.4%) for lymph node-positive cancers. The incidence of cancer greater than 50 mm remained stable from 1989 to 2004 [annual percent change: 0.2% (-2.2 to 2.7%)]. Results from the West Midlands suggest that the breast screening program did not play a significant role in reductions in mortality caused by breast cancer.