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Showing content from https://pubmed.ncbi.nlm.nih.gov/25948872/ below:

Benefits and harms of mammography screening after age 74 years: model estimates of overdiagnosis

. 2015 May 6;107(7):djv103. doi: 10.1093/jnci/djv103. Print 2015 Jul. Benefits and harms of mammography screening after age 74 years: model estimates of overdiagnosis

Affiliations

¹ Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM). n.vanravesteyn@erasmusmc.nl.
² Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).

PMID: 25948872
PMCID: PMC4822526
DOI: 10.1093/jnci/djv103

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Benefits and harms of mammography screening after age 74 years: model estimates of overdiagnosis

Nicolien T van Ravesteyn et al. J Natl Cancer Inst. 2015.

. 2015 May 6;107(7):djv103. doi: 10.1093/jnci/djv103. Print 2015 Jul. Affiliations

¹ Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM). n.vanravesteyn@erasmusmc.nl.
² Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).

PMID: 25948872
PMCID: PMC4822526
DOI: 10.1093/jnci/djv103

Item in Clipboard

Abstract

Background: The aim of this study was to quantify the benefits and harms of mammography screening after age 74 years, focusing on the amount of overdiagnosis of invasive breast cancer and ductal carcinoma in situ (DCIS).

Methods: Three well-established microsimulation models were used to simulate a cohort of American women born in 1960. All women received biennial screening starting at age 50 years with cessation ages varying from 74 up to 96 years. We estimated the number of life-years gained (LYG), quality-adjusted life-years, breast cancer deaths averted, false-positives, and overdiagnosed women per 1000 screens.

Results: The models predicted that there were 7.8 to 11.4 LYG per 1000 screens at age 74 years (range across models), decreasing to 4.8 to 7.8 LYG per 1000 screens at age 80 years, and 1.4 to 2.4 LYG per 1000 screens at age 90 years. When adjusted for quality-of-life decrements, the LYG decreased by 5% to 13% at age 74 years and 11% to 22% at age 80 years. At age 90 to 92 years, all LYG were counterbalanced by a loss in quality-of-life, mainly because of the increasing number of overdiagnosed breast cancers per 1000 screens: 1.2 to 5.0 at age 74 years, 1.8 to 6.0 at age 80 years, and 3.7 to 7.5 at age 90 years. The age at which harms began to outweigh benefits shifted to a younger age when larger or longer utility losses because of a breast cancer diagnosis were assumed.

Conclusion: The balance between screening benefits and harms becomes less favorable after age 74 years. At age 90 years, harms outweigh benefits, largely as a consequence of overdiagnosis. This age was the same across the three models, despite important model differences in assumptions on DCIS.

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Figures
Figure 1.

Schematic overview of simulated life…

Figure 1.

Schematic overview of simulated life histories and effect of screening. Sojourn time is…

Figure 1.

Schematic overview of simulated life histories and effect of screening. Sojourn time is the duration of the preclinical, screen-detectable phase of the tumor, and lead time is the interval from screen detection to the time of clinical diagnosis, when the tumor would have been diagnosed without screening. If the tumor is screen-detected without a clinical diagnosis in the absence of screening, the detection represents overdiagnosis. Lead time represents additional years that are lived with breast cancer because of screening.

Figure 2.

Age-adjusted breast cancer incidence rates…

Figure 2.

Age-adjusted breast cancer incidence rates from 1975 to 2000 predicted by the models…

Figure 2.

Age-adjusted breast cancer incidence rates from 1975 to 2000 predicted by the models vs reported to SEER for women age 70 to 79 years. SEER = Surveillance, Epidemiology, and End Results.

Figure 3.

Benefits and harms of continuing…

Figure 3.

Benefits and harms of continuing screening after age 74 years (outcomes per 1000…

Figure 3.

Benefits and harms of continuing screening after age 74 years (outcomes per 1000 screens at increasing ages). A) Number of excess invasive cancers per 1000 screens. B) Number of excess ductal carcinomas in situ (DCIS) per 1000 screens. C) Number of excess total breast cancers per 1000 screens (invasive + DCIS). D) Number of false-positives. E) Number of breast cancer deaths averted per 1000 screens. F) Number of life-years gained per 1000 screens. G) Number of quality-adjusted life-years gained per 1000 screens. H) Relative reduction in LYG after adjustment for quality of life (%). DCIS = ductal carcinoma in situ; LYG = life-years gained; QALY = quality-adjusted life-years.

Figure 4.

The number of quality-adjusted life-years…

Figure 4.

The number of quality-adjusted life-years (QALYs) gained of continuing screening after age 74…

Figure 4.

The number of quality-adjusted life-years (QALYs) gained of continuing screening after age 74 years (outcomes per 1000 screens at increasing ages). A) QALYs gained per 1000 screens assuming a utility decrement of 0.2 instead of 0.1 for ductal carcinoma in situ (DCIS) and local disease. B) Assuming utility decrements for a breast cancer diagnosis of DCIS, local and regional disease for a duration of five years instead of two years. DCIS = ductal carcinoma in situ; LYG = life-years gained; QALY = quality-adjusted life-years.