Tipping the balance of benefits and harms to favor screening mammography starting at age 40 years: a comparative modeling study of risk.
Ann Intern Med
; 156(9): 609-17, 2012 May 01.
Article
em En
| MEDLINE
| ID: mdl-22547470
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). 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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Mama
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Mamografia
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Programas de Rastreamento
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Adult
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Aged
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Female
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Humans
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Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Ann Intern Med
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Holanda