Screening outcomes in older US women undergoing multiple mammograms in community practice

Does interval, age, or comorbidity score affect tumor characteristics or false positive rates?

Dejana Braithwaite, Weiwei Zhu, Rebecca A. Hubbard, Ellen S. O'Meara, Diana L Miglioretti, Berta Geller, Kim Dittus, Dan Moore, Karen J. Wernli, Jeanne Mandelblatt, Karla Kerlikowske

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background: Uncertainty exists about the appropriate use of screening mammography among older women because comorbid illnesses may diminish the benefit of screening. We examined the risk of adverse tumor characteristics and false positive rates according to screening interval, age, and comorbidity. Methods: From January 1999 to December 2006, data were collected prospectively on 2993 older women with breast cancer and 137 949 older women without breast cancer who underwent mammography at facilities that participated in a data linkage between the Breast Cancer Surveillance Consortium and Medicare claims. Women were aged 66 to 89 years at study entry to allow for measurement of 1 year of preexisting illnesses. We used logistic regression analyses to calculate the odds of advanced (IIb, III, IV) stage, large (>20 millimeters) tumors, and 10-year cumulative probability of false-positive mammography by screening frequency (1 vs 2 years), age, and comorbidity score. The comorbidity score was derived using the Klabunde approximation of the Charlson score. All statistical tests were two-sided. Results: Adverse tumor characteristics did not differ statistically significantly by comorbidity, age, or interval. Cumulative probability of a false-positive mammography result was higher among annual screeners than biennial screeners irrespective of comorbidity: 48.0% (95% confidence interval [CI] = 46.1% to 49.9%) of annual screeners aged 66 to 74 years had a false-positive result compared with 29.0% (95% CI = 28.1% to 29.9%) of biennial screeners.ConclusionWomen aged 66 to 89 years who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of a false-positive recommendation than annual screeners, regardless of comorbidity.

Original languageEnglish (US)
Pages (from-to)334-341
Number of pages8
JournalJournal of the National Cancer Institute
Volume105
Issue number5
DOIs
StatePublished - Mar 6 2013
Externally publishedYes

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Mammography
Comorbidity
Neoplasms
Breast Neoplasms
Confidence Intervals
Preexisting Condition Coverage
Information Storage and Retrieval
Medicare
Uncertainty
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Screening outcomes in older US women undergoing multiple mammograms in community practice : Does interval, age, or comorbidity score affect tumor characteristics or false positive rates? / Braithwaite, Dejana; Zhu, Weiwei; Hubbard, Rebecca A.; O'Meara, Ellen S.; Miglioretti, Diana L; Geller, Berta; Dittus, Kim; Moore, Dan; Wernli, Karen J.; Mandelblatt, Jeanne; Kerlikowske, Karla.

In: Journal of the National Cancer Institute, Vol. 105, No. 5, 06.03.2013, p. 334-341.

Research output: Contribution to journalArticle

Braithwaite, Dejana ; Zhu, Weiwei ; Hubbard, Rebecca A. ; O'Meara, Ellen S. ; Miglioretti, Diana L ; Geller, Berta ; Dittus, Kim ; Moore, Dan ; Wernli, Karen J. ; Mandelblatt, Jeanne ; Kerlikowske, Karla. / Screening outcomes in older US women undergoing multiple mammograms in community practice : Does interval, age, or comorbidity score affect tumor characteristics or false positive rates?. In: Journal of the National Cancer Institute. 2013 ; Vol. 105, No. 5. pp. 334-341.
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abstract = "Background: Uncertainty exists about the appropriate use of screening mammography among older women because comorbid illnesses may diminish the benefit of screening. We examined the risk of adverse tumor characteristics and false positive rates according to screening interval, age, and comorbidity. Methods: From January 1999 to December 2006, data were collected prospectively on 2993 older women with breast cancer and 137 949 older women without breast cancer who underwent mammography at facilities that participated in a data linkage between the Breast Cancer Surveillance Consortium and Medicare claims. Women were aged 66 to 89 years at study entry to allow for measurement of 1 year of preexisting illnesses. We used logistic regression analyses to calculate the odds of advanced (IIb, III, IV) stage, large (>20 millimeters) tumors, and 10-year cumulative probability of false-positive mammography by screening frequency (1 vs 2 years), age, and comorbidity score. The comorbidity score was derived using the Klabunde approximation of the Charlson score. All statistical tests were two-sided. Results: Adverse tumor characteristics did not differ statistically significantly by comorbidity, age, or interval. Cumulative probability of a false-positive mammography result was higher among annual screeners than biennial screeners irrespective of comorbidity: 48.0{\%} (95{\%} confidence interval [CI] = 46.1{\%} to 49.9{\%}) of annual screeners aged 66 to 74 years had a false-positive result compared with 29.0{\%} (95{\%} CI = 28.1{\%} to 29.9{\%}) of biennial screeners.ConclusionWomen aged 66 to 89 years who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of a false-positive recommendation than annual screeners, regardless of comorbidity.",
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T1 - Screening outcomes in older US women undergoing multiple mammograms in community practice

T2 - Does interval, age, or comorbidity score affect tumor characteristics or false positive rates?

AU - Braithwaite, Dejana

AU - Zhu, Weiwei

AU - Hubbard, Rebecca A.

AU - O'Meara, Ellen S.

AU - Miglioretti, Diana L

AU - Geller, Berta

AU - Dittus, Kim

AU - Moore, Dan

AU - Wernli, Karen J.

AU - Mandelblatt, Jeanne

AU - Kerlikowske, Karla

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N2 - Background: Uncertainty exists about the appropriate use of screening mammography among older women because comorbid illnesses may diminish the benefit of screening. We examined the risk of adverse tumor characteristics and false positive rates according to screening interval, age, and comorbidity. Methods: From January 1999 to December 2006, data were collected prospectively on 2993 older women with breast cancer and 137 949 older women without breast cancer who underwent mammography at facilities that participated in a data linkage between the Breast Cancer Surveillance Consortium and Medicare claims. Women were aged 66 to 89 years at study entry to allow for measurement of 1 year of preexisting illnesses. We used logistic regression analyses to calculate the odds of advanced (IIb, III, IV) stage, large (>20 millimeters) tumors, and 10-year cumulative probability of false-positive mammography by screening frequency (1 vs 2 years), age, and comorbidity score. The comorbidity score was derived using the Klabunde approximation of the Charlson score. All statistical tests were two-sided. Results: Adverse tumor characteristics did not differ statistically significantly by comorbidity, age, or interval. Cumulative probability of a false-positive mammography result was higher among annual screeners than biennial screeners irrespective of comorbidity: 48.0% (95% confidence interval [CI] = 46.1% to 49.9%) of annual screeners aged 66 to 74 years had a false-positive result compared with 29.0% (95% CI = 28.1% to 29.9%) of biennial screeners.ConclusionWomen aged 66 to 89 years who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of a false-positive recommendation than annual screeners, regardless of comorbidity.

AB - Background: Uncertainty exists about the appropriate use of screening mammography among older women because comorbid illnesses may diminish the benefit of screening. We examined the risk of adverse tumor characteristics and false positive rates according to screening interval, age, and comorbidity. Methods: From January 1999 to December 2006, data were collected prospectively on 2993 older women with breast cancer and 137 949 older women without breast cancer who underwent mammography at facilities that participated in a data linkage between the Breast Cancer Surveillance Consortium and Medicare claims. Women were aged 66 to 89 years at study entry to allow for measurement of 1 year of preexisting illnesses. We used logistic regression analyses to calculate the odds of advanced (IIb, III, IV) stage, large (>20 millimeters) tumors, and 10-year cumulative probability of false-positive mammography by screening frequency (1 vs 2 years), age, and comorbidity score. The comorbidity score was derived using the Klabunde approximation of the Charlson score. All statistical tests were two-sided. Results: Adverse tumor characteristics did not differ statistically significantly by comorbidity, age, or interval. Cumulative probability of a false-positive mammography result was higher among annual screeners than biennial screeners irrespective of comorbidity: 48.0% (95% confidence interval [CI] = 46.1% to 49.9%) of annual screeners aged 66 to 74 years had a false-positive result compared with 29.0% (95% CI = 28.1% to 29.9%) of biennial screeners.ConclusionWomen aged 66 to 89 years who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of a false-positive recommendation than annual screeners, regardless of comorbidity.

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DO - 10.1093/jnci/djs645

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