Clinical outcomes of modelling mammography screening strategies

Martin J. Yaffe*, Nicole Mittmann, Pablo Lee, Anna N.A. Tosteson, Amy Trentham-Dietz, Oguzhan Alagoz, Natasha K. Stout

*Corresponding author for this work

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Background: A validated breast cancer model can be used to compare health outcomes associated with different screening strategies. Data and methods: The University of Wisconsin Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer microsimulation model was adapted to simulate breast cancer incidence, screening performance and delivery of optimal therapies in Canada. The model considered effects of breast density on incidence and screening performance. Model predictions of incidence, mortality and life-years (LY) gained for a 1960 birth cohort of women for No Screening were compared with 11 digital mammography screening strategies that varied by starting and stopping age and frequency. Results: In the absence of screening, the estimate of LYs lost from breast cancer was 360.1 per 1,000 women, and each woman diagnosed with breast cancer after age 40 who dies of breast cancer would lose an estimated average of 19.1 years. Biennial screening at ages 50 to 74 resulted in an estimated 116.3 LYs saved. Annual screening at ages 40 to 49, followed by biennial screening to age 74, resulted in an estimated 170.3 LY saved. That is, adding annual screening at ages 40 to 49 saved an additional 54 LY per 1,000 women. Screening annually at ages 40 to 74 recovered the most: 214 LY saved. More frequent screening was associated with an increased ratio of detection of ductal in situ to invasive cancers, more abnormal recalls and more negative biopsies, but a reduction in the number of women required to be screened per life saved or per LY saved. Interpretation: In general, mortality reduction was found to be associated with the total number of lifetime screens for breast cancer. However, for the same number of screens, more frequent screening after age 50 appeared to have a greater impact on breast cancer deaths averted than did beginning screening earlier. When the number of LYs saved by screening was considered, a greater impact was achieved by screening women in their 40s than by reducing the interval between screens.

Original languageEnglish (US)
Pages (from-to)9-15
Number of pages7
JournalHealth Reports
Volume26
Issue number12
StatePublished - 2015

Keywords

  • Breast screening
  • Health outcomes
  • Microsimulation model
  • Preventive health

ASJC Scopus subject areas

  • Demography
  • Public Health, Environmental and Occupational Health

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