Collaborative Modeling of the Benefits and Harms Associated With Different U.S. Breast Cancer Screening Strategies

• DOI: 10.7326/m15-1536
• Publication Date: 2016-01-12T22:21:34Z
• Authors: Jeanne S. Mandelb...; Natasha K. Stout; Clyde B. Schechter; Jeroen J. van den...; Diana L. Miglioretti; Martin Krapcho; Amy Trentham-Dietz; Diego Munoz; Sandra J. Lee; Donald A. Berry; Nicolien T. van R...; Oguzhan Alagoz; Karla Kerlikowske; Anna N.A. Tosteson; Aimee M. Near; Amanda Hoeffken; Yaojen Chang; Eveline A. Heijns...; Gary Chisholm; Xuelin Huang; Hui Huang; Mehmet Ali Ergun; Ronald Gangnon; Brian L. Sprague; Sylvia Plevritis; Eric Feuer; Harry J. de Koning; Kathleen A. Cronin
• Keywords: Overdiagnosis; Breast Cancer Screening; Mammography screening

Background: Controversy persists about optimal mammography screening strategies. Objective: To evaluate outcomes, taking into account advances in and treatment of breast cancer. Design: Collaboration 6 simulation models using national data on incidence, digital performance, effects, other-cause mortality. Setting: United States. Patients: Average-risk U.S. female population subgroups with varying risk, density, or comorbidity. Intervention: Eight strategies differing by age at which starts (40, 45, 50 years) interval (annual, biennial, hybrid [annual for women their 40s biennial thereafter]). All assumed 100% adherence stopped 74 years. Measurements: Benefits (breast cancer–specific mortality reduction, cancer deaths averted, life-years, quality-adjusted life-years); number mammograms used; harms (false-positive results, benign biopsies, overdiagnosis); ratios (or use) benefits (efficiency) per 1000 screens. Results: Biennial were consistently the most efficient average-risk women. from to years avoided a median 7 versus no screening; annual 40 an additional 3 deaths, but yielded 1988 more false-positive results 11 overdiagnoses screened. Annual was inefficient (similar benefits, than other strategies). For groups 2- 4-fold increased had similar as biennially moderate severe comorbidity, could stop 66 68 Limitation: Other imaging technologies, polygenic nonadherence not considered. Conclusion: is populations. Decisions starting ages intervals will depend characteristics decision makers' weight given screening. Primary Funding Source: National Institutes Health.