Collaborative Modeling of the Benefits and Harms Associated With Different U.S. Breast Cancer Screening Strategies
| Autor: | Jeanne S. Mandelblatt, Hui Huang, Sandra J. Lee, Natasha K. Stout, Amanda Hoeffken, Amy Trentham-Dietz, Brian L. Sprague, Donald A. Berry, Yaojen Chang, Diego F. Munoz, Sylvia K. Plevritis, Clyde B. Schechter, Diana L. Miglioretti, Anna N. A. Tosteson, Nicolien T. van Ravesteyn, Mehmet Ali Ergun, Martin Krapcho, Harry J. de Koning, Oguzhan Alagoz, Gary B. Chisholm, K. A. Cronin, Xuelin Huang, Jeroen J. van den Broek, Eric J. Feuer, Eveline A.M. Heijnsdijk, Aimee M. Near, Karla Kerlikowske, Ronald E. Gangnon |
|---|---|
| Přispěvatelé: | Public Health |
| Rok vydání: | 2016 |
| Předmět: |
Time Factors
Comorbidity Medical and Health Sciences Breast cancer screening 0302 clinical medicine Cancer screening Epidemiology of cancer Medicine Mass Screening 030212 general & internal medicine Breast Overdiagnosis Early Detection of Cancer Cancer education.field_of_study medicine.diagnostic_test Incidence Age Factors General Medicine Middle Aged Health Services 030220 oncology & carcinogenesis Biomedical Imaging Female Mammography Adult medicine.medical_specialty Population Breast Neoplasms Risk Assessment Article 03 medical and health sciences Breast cancer SDG 3 - Good Health and Well-being Clinical Research General & Internal Medicine Breast Cancer Internal Medicine Humans False Positive Reactions Computer Simulation education Mass screening Aged Gynecology business.industry Prevention medicine.disease Annual Screening United States Good Health and Well Being business Demography |
| Zdroj: | Annals of internal medicine, vol 164, iss 4 Annals of Internal Medicine, 164(4), 215-+. American College of Physicians |
| ISSN: | 0003-4819 |
| Popis: | BackgroundControversy persists about optimal mammography screening strategies.ObjectiveTo evaluate screening outcomes, taking into account advances in mammography and treatment of breast cancer.DesignCollaboration of 6 simulation models using national data on incidence, digital mammography performance, treatment effects, and other-cause mortality.SettingUnited States.PatientsAverage-risk U.S. female population and subgroups with varying risk, breast density, or comorbidity.InterventionEight 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.MeasurementsBenefits (breast cancer-specific mortality reduction, breast cancer deaths averted, life-years, and quality-adjusted 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.ResultsBiennial 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 benefits, 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.LimitationOther imaging technologies, polygenic risk, and nonadherence were not considered.ConclusionBiennial 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.Primary funding sourceNational Institutes of Health. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|