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Tipping the balance of benefits and harms to favor screening mammography starting at age 40 years: a comparative modeling study of risk.

Abstract：

BACKGROUND:Timing of initiation of screening for breast cancer is controversial in the United States. OBJECTIVE:To determine the threshold relative risk (RR) at which the harm-benefit ratio of screening women aged 40 to 49 years equals that of biennial screening for women aged 50 to 74 years. DESIGN:Comparative modeling study. DATA SOURCES:Surveillance, Epidemiology, and End Results program, Breast Cancer Surveillance Consortium, and medical literature. TARGET POPULATION:A contemporary cohort of women eligible for routine screening. TIME HORIZON:Lifetime. PERSPECTIVE:Societal. INTERVENTION:Mammography screening starting at age 40 versus 50 years with different screening methods (film, digital) and screening intervals (annual, biennial). OUTCOME MEASURES: BENEFITS:life-years gained, breast cancer deaths averted; harms: false-positive mammography findings; harm-benefit ratios: false-positive findings/life-years gained, false-positive findings/deaths averted. RESULTS OF BASE-CASE ANALYSIS:Screening average-risk women aged 50 to 74 years biennially yields the same false-positive findings/life-years gained as biennial screening with digital mammography starting at age 40 years for women with a 2-fold increased risk above average (median threshold RR, 1.9 [range across models, 1.5 to 4.4]). The threshold RRs are higher for annual screening with digital mammography (median, 4.3 [range, 3.3 to 10]) and when false-positive findings/deaths averted is used as an outcome measure instead of false-positive findings/life-years gained. The harm-benefit ratio for film mammography is more favorable than for digital mammography because film has a lower false-positive rate. RESULTS OF SENSITIVITY ANALYSIS:The threshold RRs changed slightly when a more comprehensive measure of harm was used and were relatively insensitive to lower adherence assumptions. LIMITATION:Risk was assumed to influence onset of disease without influencing screening performance. CONCLUSION:Women aged 40 to 49 years with a 2-fold increased risk have similar harm-benefit ratios for biennial screening mammography as average-risk women aged 50 to 74 years. Threshold RRs required for favorable harm-benefit ratios vary by screening method, interval, and outcome measure. PRIMARY FUNDING SOURCE:National Cancer Institute.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

van Ravesteyn NT,Miglioretti DL,Stout NK,Lee SJ,Schechter CB,Buist DS,Huang H,Heijnsdijk EA,Trentham-Dietz A,Alagoz O,Near AM,Kerlikowske K,Nelson HD,Mandelblatt JS,de Koning HJ

doi

10.7326/0003-4819-156-9-201205010-00002

subject

Has Abstract

pub_date

2012-05-01 00:00:00

pages

609-17

issue

eissn

0003-4819

issn

1539-3704

pii

156/9/609

journal_volume

156

pub_type

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Tipping the balance of benefits and harms to favor screening mammography starting at age 40 years: a comparative modeling study of risk.