Abstract:
BACKGROUND:Many states have laws requiring mammography facilities to tell women with dense breasts and negative results on screening mammography to discuss supplemental screening tests with their providers. The most readily available supplemental screening method is ultrasonography, but little is known about its effectiveness. OBJECTIVE:To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts. DESIGN:Comparative modeling with 3 validated simulation models. DATA SOURCES:Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; and medical literature. TARGET POPULATION:Contemporary cohort of women eligible for routine screening. TIME HORIZON:Lifetime. PERSPECTIVE:Payer. INTERVENTION:Supplemental ultrasonography screening for women with dense breasts after a negative screening mammography result. OUTCOME MEASURES:Breast cancer deaths averted, quality-adjusted life-years (QALYs) gained, biopsies recommended after a false-positive ultrasonography result, and costs. RESULTS OF BASE-CASE ANALYSIS:Supplemental ultrasonography screening after a negative mammography result for women aged 50 to 74 years with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models, 0.14 to 0.75), gained 1.7 QALYs (range, 0.9 to 4.7), and resulted in 354 biopsy recommendations after a false-positive ultrasonography result (range, 345 to 421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained (range, $112,000 to $766,000). Supplemental ultrasonography screening for only women with extremely dense breasts cost $246,000 per QALY gained (range, $74,000 to $535,000). RESULTS OF SENSITIVITY ANALYSIS:The conclusions were not sensitive to ultrasonography performance characteristics, screening frequency, or starting age. LIMITATION:Provider costs for coordinating supplemental ultrasonography were not considered. CONCLUSION:Supplemental ultrasonography screening for women with dense breasts would substantially increase costs while producing relatively small benefits. PRIMARY FUNDING SOURCE:National Cancer Institute.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Sprague BL,Stout NK,Schechter C,van Ravesteyn NT,Cevik M,Alagoz O,Lee CI,van den Broek JJ,Miglioretti DL,Mandelblatt JS,de Koning HJ,Kerlikowske K,Lehman CD,Tosteson ANdoi
10.7326/M14-0692subject
Has Abstractpub_date
2015-02-03 00:00:00pages
157-66issue
3eissn
0003-4819issn
1539-3704pii
2020458journal_volume
162pub_type
杂志文章abstract:OBJECTIVE:To determine whether diabetic patients, when compared with nondiabetic patients, have a higher incidence of restenosis after coronary stenting, and, if so, whether restenosis is attributable to lesion or procedural differences or to a greater biologic tendency for late loss of minimum diameter in diabetic pat...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
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abstract::To assess the course and prognosis of salicylate-induced pulmonary edema, we reviewed the records of 36 consecutive patients admitted with serum salicylate levels greater than 30 mg/dL. Pulmonary edema developed in eight patients, and pulmonary infiltrates were never seen in 28 patients. Several features distinguished...
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