Which Mammography Recommendation Results in the Greatest Breast Cancer Mortality Reduction?
BACKGROUND AND PURPOSE:
Evidence demonstrates a reduction in breast cancer deaths due to routine screening mammography
Data limitations remain, even with RCTs, due to older mammography machines, different protocols and possible noncompliance
Computer models can overcome some of these issues
NCI has funded the Cancer Intervention and Surveillance Modeling Network (CISNET) to develop these models
Arleo et al. (Cancer, 2017) sought to determine which screening approach prevented the most deaths
Benefits and risks of each screening technique were used to evaluate three common screening guideline approaches
Annual screening at ages 40 to 84 y/o (Option 1)
Annual screening at ages 45 to 54 y/o, and biennially 55 to 79 y/o (Option 2)
Annual screening at ages 50-74 y/o (Option 3)
CISNET had six groups at different institutions develop independent computer models
Input parameters estimates of breast cancer incidence, survival trends with and without screening or adjuvant therapy, mammography performance data from the Breast Cancer Surveillance Consortium (BCSC), and breast cancer-specific mortality data from the SEER Program
Risk of overdiagnosis was not included
Mean mortality reduction was greatest with Option 1 (39.6%) compared to Option 2 (30.8%) and Option 3 (23.2%)
Option 1 would avert the greatest number of breast cancer deaths (29,369) compared to Option 2 (22,829) and Option 3 (15,599; cohort of women born in 1970)
Option 1 would also lead to the most mammograms (90.2 million), benign recalls (6.8 million), and benign biopsies (481,269) compared to Option 2 (49.0 million, 4.1 million, and 286,288, respectively) or Option 3 (27.3 million, 2.3 million, and 162,885, respectively)
Mean mortality reduction is greatest in with annual screening beginning at age 40 (39.6%) compared to hybrid annual/biennial (30.8%) or annual screening beginning at age 50 (26.6% using 1970 birth cohort).
In the accompanying editorial, the author summarizes the evidence used by guideline committees
Regular screening is effective in reducing breast cancer mortality for women aged 40 to 74 years
The likelihood of screening benefit increases with age (mammography is a better test for women in their 50s than it is for women in their 40s)
There is risk of harm associated with screening
One must balance the benefits and risks when deciding about screening
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