Tailoring Breast Cancer Screening Intervals by Breast Density and Risk for Women Aged 50 Years or Older: Collaborative Modeling of Screening Outcomes.

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Background

Biennial screening is generally recommended for average-risk women aged 50 to 74 years, but tailored screening may provide greater benefits.

Objective

To estimate outcomes for various screening intervals after age 50 years based on breast density and risk for breast cancer.

Design

Collaborative simulation modeling using national incidence, breast density, and screening performance data.

Setting

United States.

Patients

Women aged 50 years or older with various combinations of breast density and relative risk (RR) of 1.0, 1.3, 2.0, or 4.0.

Intervention

Annual, biennial, or triennial digital mammography screening from ages 50 to 74 years (vs. no screening) and ages 65 to 74 years (vs. biennial digital mammography from ages 50 to 64 years).

Measurements

Lifetime breast cancer deaths, life expectancy and quality-adjusted life-years (QALYs), false-positive mammograms, benign biopsy results, overdiagnosis, cost-effectiveness, and ratio of false-positive results to breast cancer deaths averted.

Results

Screening benefits and overdiagnosis increase with breast density and RR. False-positive mammograms and benign results on biopsy decrease with increasing risk. Among women with fatty breasts or scattered fibroglandular density and an RR of 1.0 or 1.3, breast cancer deaths averted were similar for triennial versus biennial screening for both age groups (50 to 74 years, median of 3.4 to 5.1 vs. 4.1 to 6.5 deaths averted; 65 to 74 years, median of 1.5 to 2.1 vs. 1.8 to 2.6 deaths averted). Breast cancer deaths averted increased with annual versus biennial screening for women aged 50 to 74 years at all levels of breast density and an RR of 4.0, and those aged 65 to 74 years with heterogeneously or extremely dense breasts and an RR of 4.0. However, harms were almost 2-fold higher. Triennial screening for the average-risk subgroup and annual screening for the highest-risk subgroup cost less than $100 000 per QALY gained.

Limitation

Models did not consider women younger than 50 years, those with an RR less than 1, or other imaging methods.

Conclusion

Average-risk women with low breast density undergoing triennial screening and higher-risk women with high breast density receiving annual screening will maintain a similar or better balance of benefits and harms than average-risk women receiving biennial screening.

Primary Funding Source

National Cancer Institute.

Abbreviation
Ann. Intern. Med.
Publication Date
2015-12-23
Pubmed ID
27548583
Medium
Print-Electronic
Full Title
Tailoring Breast Cancer Screening Intervals by Breast Density and Risk for Women Aged 50 Years or Older: Collaborative Modeling of Screening Outcomes.
Authors
Trentham-Dietz A, Kerlikowske K, Stout NK, Miglioretti DL, Schechter CB, Ergun MA, van den Broek JJ, Alagoz O, Sprague BL, van Ravesteyn NT, Near AM, Gangnon RE, Hampton JM, Chandler Y, de Koning HJ, Mandelblatt JS, Tosteson AN,