Abstract
Objectives: Incidence-based mortality quantifies the distribution of cancer deaths and life-years lost, according to age at detection. We investigated the temporal distribution of the disease burden, and the effect of starting and stopping ages and interval between screening mammography examinations, on incidence-based mortality. Methods: Incidence-based mortality was estimated using an established breast cancer simulation model, adapted and validated to simulate breast cancer incidence, screening performance, and delivery of therapies in Canada. Ten strategies were examined, with varying starting age (40 or 50), stopping age (69 or 74), and interval (1, 2, 3 years), and “No Screening.” Life-years lost were computed as the difference between model predicted time of breast cancer death and that estimated from life tables. Results: Without screening, 70% of the burden in terms of breast cancer deaths extends between ages 45 and 75. The mean of the distribution of ages of detection of breast cancers that will be fatal in an unscreened population is 61.8 years, while the mean age of detection weighted by the number of life-years lost is 55, a downward shift of 6.8 years. Similarly, the mean age of detection for the distribution of life-years gained through screening is lower than that for breast cancer deaths averted. Conclusion: Incidence-based mortality predictions from modeling elucidate the age dependence of the breast cancer burden and can provide guidance for optimizing the timing of screening regimens to achieve maximal impact. Of the regimens studied, the greatest lifesaving effect was achieved with annual screening beginning at age 40.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 197-204 |
| Number of pages | 8 |
| Journal | Journal of Medical Screening |
| Volume | 25 |
| Issue number | 4 |
| DOIs | |
| State | Published - Jan 1 2018 |
Funding
We are grateful to Statistics Canada and to Dr Michael Wolfson at the University of Ottawa for supplying key incidence data. The content is solely the responsibility of the authors and does not necessarily represent the official views of Statistics Canada, the National Cancer Institute or the National Institutes of Health. We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study. A list of the BCSC investigators and procedures for requesting BCSC data for research purposes are provided at: http://breastscreening. cancer.gov/. The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work was supported by a contract from The Canadian Breast Cancer Foundation. The University of Wisconsin breast cancer simulation model used in this analysis was also supported by grant number U01 CA152958 from the National Cancer Institute as part of the CISNET. Model input data on the performance of screening mammography was also supported by the National Cancer Institute-funded BCSC grant number UC2CA148577 and contract number HHSN261201100031C. For a full description of U.S. data sources, please see: http://www.breastscreening.cancer.gov/work/acknowledgement.html. To discuss use of model run data, please contact Dr Yaffe. The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work was supported by a contract from The Canadian Breast Cancer Foundation. The University of Wisconsin breast cancer simulation model used in this analysis was also supported by grant number U01 CA152958 from the National Cancer Institute as part of the CISNET. Model input data on the performance of screening mammography was also supported by the National Cancer Institute-funded BCSC grant number UC2CA148577 and contract number HHSN261201100031C. For a full description of U.S. data sources, please see: http://www.breastscreening.cancer.gov/work/acknowledgement.html. To discuss use of model run data, please contact Dr Yaffe.
Keywords
- Age to begin screening
- Breast cancer screening
- Incidence-based mortality
- Mammography
- Mammography screening regimens
- Quality-adjusted lifeyears
- Screening interval
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Health Policy
