Collaborative modeling of the benefits and harms associated with different U.S. Breast cancer screening strategies

Jeanne S. Mandelblatt, Natasha K. Stout, Clyde B. Schechter, Jeroen J. Van Den Broek, Diana L Miglioretti, Martin Krapcho, Amy Trentham-Dietz, Diego Munoz, Sandra J. Lee, Donald A. Berry, Nicolien T. Van Ravesteyn, Oguzhan Alagoz, Karla Kerlikowske, Anna N A Tosteson, Aimee M. Near, Amanda Hoeffken, Yaojen Chang, Eveline A. Heijnsdijk, Gary Chisholm, Xuelin HuangHui Huang, Mehmet Ali Ergun, Ronald Gangnon, Brian L. Sprague, Sylvia Plevritis, Eric Feuer, Harry J. De Koning, Kathleen A. Cronin

Research output: Contribution to journalArticle

105 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)215-225
Number of pages11
JournalAnnals of Internal Medicine
Volume164
Issue number4
DOIs
StatePublished - Feb 16 2016

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

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    Mandelblatt, J. S., Stout, N. K., Schechter, C. B., Van Den Broek, J. J., Miglioretti, D. L., Krapcho, M., Trentham-Dietz, A., Munoz, D., Lee, S. J., Berry, D. A., Van Ravesteyn, N. T., Alagoz, O., Kerlikowske, K., Tosteson, A. N. A., Near, A. M., Hoeffken, A., Chang, Y., Heijnsdijk, E. A., Chisholm, G., ... Cronin, K. A. (2016). Collaborative modeling of the benefits and harms associated with different U.S. Breast cancer screening strategies. Annals of Internal Medicine, 164(4), 215-225. https://doi.org/10.7326/M15-1536