TY - JOUR
T1 - Collaborative modeling of the benefits and harms associated with different U.S. Breast cancer screening strategies
AU - Mandelblatt, Jeanne S.
AU - Stout, Natasha K.
AU - Schechter, Clyde B.
AU - Van Den Broek, Jeroen J.
AU - Miglioretti, Diana L.
AU - Krapcho, Martin
AU - Trentham-Dietz, Amy
AU - Munoz, Diego
AU - Lee, Sandra J.
AU - Berry, Donald A.
AU - Van Ravesteyn, Nicolien T.
AU - Alagoz, Oguzhan
AU - Kerlikowske, Karla
AU - Tosteson, Anna N.A.
AU - Near, Aimee M.
AU - Hoeffken, Amanda
AU - Chang, Yaojen
AU - Heijnsdijk, Eveline A.
AU - Chisholm, Gary
AU - Huang, Xuelin
AU - Huang, Hui
AU - Ergun, Mehmet Ali
AU - Gangnon, Ronald
AU - Sprague, Brian L.
AU - Plevritis, Sylvia
AU - Feuer, Eric
AU - De Koning, Harry J.
AU - Cronin, Kathleen A.
PY - 2016/2/16
Y1 - 2016/2/16
N2 - Background: Controversy persists about optimal mammography screening strategies. Objective: To evaluate screening outcomes, taking into account advances in mammography and treatment of breast cancer. Design: Collaboration of 6 simulation models using national data on incidence, digital mammography performance, treatment effects, and other-cause mortality. Setting: United States. Patients: Average-risk U.S. female population and subgroups with varying risk, breast density, or comorbidity. Intervention: Eight strategies differing by age at which screening starts (40, 45, or 50 years) and screening interval (annual, biennial, and hybrid [annual for women in their 40s and biennial thereafter]). All strategies assumed 100% adherence and stopped at age 74 years. Measurements: Benefits (breast cancer-specific mortality reduction, breast cancer deaths averted, life-years, and qualityadjusted life-years); number of mammograms used; harms (false-positive results, benign biopsies, and overdiagnosis); and ratios of harms (or use) and benefits (efficiency) per 1000 screens. Results: Biennial strategies were consistently the most efficient for average-risk women. Biennial screening from age 50 to 74 years avoided a median of 7 breast cancer deaths versus no screening; annual screening from age 40 to 74 years avoided an additional 3 deaths, but yielded 1988 more false-positive results and 11 more overdiagnoses per 1000 women screened. Annual screening from age 50 to 74 years was inefficient (similar bene-fits, but more harms than other strategies). For groups with a 2-to 4-fold increased risk, annual screening from age 40 years had similar harms and benefits as screening average-risk women biennially from 50 to 74 years. For groups with moderate or severe comorbidity, screening could stop at age 66 to 68 years. Limitation: Other imaging technologies, polygenic risk, and nonadherence were not considered. Conclusion: Biennial screening for breast cancer is efficient for average-risk populations. Decisions about starting ages and intervals will depend on population characteristics and the decision makers' weight given to the harms and benefits of screening.
AB - Background: Controversy persists about optimal mammography screening strategies. Objective: To evaluate screening outcomes, taking into account advances in mammography and treatment of breast cancer. Design: Collaboration of 6 simulation models using national data on incidence, digital mammography performance, treatment effects, and other-cause mortality. Setting: United States. Patients: Average-risk U.S. female population and subgroups with varying risk, breast density, or comorbidity. Intervention: Eight strategies differing by age at which screening starts (40, 45, or 50 years) and screening interval (annual, biennial, and hybrid [annual for women in their 40s and biennial thereafter]). All strategies assumed 100% adherence and stopped at age 74 years. Measurements: Benefits (breast cancer-specific mortality reduction, breast cancer deaths averted, life-years, and qualityadjusted life-years); number of mammograms used; harms (false-positive results, benign biopsies, and overdiagnosis); and ratios of harms (or use) and benefits (efficiency) per 1000 screens. Results: Biennial strategies were consistently the most efficient for average-risk women. Biennial screening from age 50 to 74 years avoided a median of 7 breast cancer deaths versus no screening; annual screening from age 40 to 74 years avoided an additional 3 deaths, but yielded 1988 more false-positive results and 11 more overdiagnoses per 1000 women screened. Annual screening from age 50 to 74 years was inefficient (similar bene-fits, but more harms than other strategies). For groups with a 2-to 4-fold increased risk, annual screening from age 40 years had similar harms and benefits as screening average-risk women biennially from 50 to 74 years. For groups with moderate or severe comorbidity, screening could stop at age 66 to 68 years. Limitation: Other imaging technologies, polygenic risk, and nonadherence were not considered. Conclusion: Biennial screening for breast cancer is efficient for average-risk populations. Decisions about starting ages and intervals will depend on population characteristics and the decision makers' weight given to the harms and benefits of screening.
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U2 - 10.7326/M15-1536
DO - 10.7326/M15-1536
M3 - Article
C2 - 26756606
AN - SCOPUS:84958818486
SN - 0003-4819
VL - 164
SP - 215
EP - 225
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 4
ER -
