Display Settings:

Format

Send to:

Choose Destination
We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Ann Intern Med. 2012 May 1;156(9):609-17. doi: 10.7326/0003-4819-156-9-201205010-00002.

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

Author information

  • 1Erasmus Medical Center, Rotterdam, the Netherlands. n.vanravesteyn@erasmusmc.nl

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.

Comment in

PMID:
22547470
[PubMed - indexed for MEDLINE]
PMCID:
PMC3520058
Free PMC Article

Images from this publication.See all images (1)Free text

Figure 1
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Icon for Silverchair Information Systems Icon for PubMed Central
    Loading ...
    Write to the Help Desk