BACKGROUND AND PURPOSE:

• Schousboe et al. (Annals of Internal Medicine, 2021) estimated the benefits, harms, and cost-effectiveness of extending mammography to age 80, 85, or 90 years

METHODS:

• Simulation model
• Population
  • U.S. women aged 65 to 90 years
  • Data derived from SEER program and Breast Cancer Surveillance Consortium
• Exposure
  • Screening mammography to age 75, 80, 85, or 90 years
• Comorbidities
  • Scored using Charlson comorbidity score (CCS) | Predicts mortality by classifying and weighting comorbid conditions
• Primary outcomes
  • Breast cancer death
  • Survival
  • Costs per quality-adjusted life-year (QALY)

RESULTS:

• Extending biennial mammography from age 75 to 80
  • Averted breast cancer deaths
    • Comorbidity score 0: 1.7 deaths per 1000 women
    • Comorbidity score 1: 1.4 deaths per 1000 women
    • Comorbidity score ≥2: 1.0 deaths per 1000 women
  • Increased days of life gained
    • Comorbidity score 0: 5.8 days per 1000 women
    • Comorbidity score 1: 4.2 days per 1000 women
    • Comorbidity score ≥2: 2.7 days per 1000 women
• Cost-effectiveness
  • Annual mammography beyond age 75 years was not cost-effective
  • Extending biennial mammography to age 80 years was cost-effective
    • Comorbidity score 0: $54,000 per QALY gained
    • Comorbidity score 1: $65,000 per QALY gained
    • Comorbidity score ≥2: $85,000 per QALY gained
• Overdiagnosis cases were approximately double the number of deaths averted from breast cancer
  • Comorbidity score 0: 4.0 overdiagnoses per 1000 women
  • Comorbidity score 1: 3.3 overdiagnoses per 1000 women
  • Comorbidity score ≥2: 2.7 overdiagnoses per 1000 women

CONCLUSION:

• Biennial mammography screening to age 80 is cost-effective especially for women with few comorbidities
• The authors state

However, the absolute number of averted breast cancer deaths and days of life gained are small, especially for those with comorbidities

Women considering screening beyond age 75 years need to weigh the harms of overdiagnosis versus the potential benefit of averting death from breast cancer 

Learn More – Primary Sources:

Cost-Effectiveness of Screening Mammography Beyond Age 75 Years: A Cost-Effectiveness Analysis

Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries

Related ObG Topics:

How Effective Is Mammography in Reducing the Number of Advanced Breast Cancer Diagnoses?

Which Mammography Recommendation Results in the Greatest Breast Cancer Mortality Reduction?