Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms
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Summary
This summary is machine-generated.Biennial breast cancer screening offers most benefits of annual screening with fewer harms. Optimal strategy balances benefits, harms, and resources for individual and program goals.
Area Of Science
- Oncology
- Public Health
- Medical Imaging
Background
- Mammography is widely used for breast cancer screening, but optimal screening policies remain debated.
- Controversy exists regarding the ideal mammography screening schedule and age parameters.
Purpose Of The Study
- To evaluate and compare various United States breast cancer screening strategies.
- To determine the effectiveness and harms of different mammography screening protocols.
Main Methods
- Utilized six distinct mathematical models with shared data elements.
- Incorporated national data on breast cancer incidence, mortality, mammography performance, and treatment outcomes.
- Modeled 20 screening strategies varying in initiation/cessation ages and frequency (annual/biennial) over a lifetime horizon.
Main Results
- Consistent rankings of screening strategies emerged across all models.
- Biennial screening retained 81% of annual screening benefits while reducing false positives by nearly half.
- Biennial screening from ages 50-69 years reduced breast cancer deaths by a median of 16.5% compared to no screening.
- Early initiation (age 40) or extending screening past age 69 yielded marginal mortality benefits but increased harms like overdiagnosis and false positives.
Conclusions
- Biennial screening is an effective strategy, achieving substantial breast cancer mortality reduction with reduced harms compared to annual screening.
- The optimal screening strategy depends on balancing benefits (mortality reduction, life-years gained) against harms (false positives, overdiagnosis) and resource considerations.
- Study limitations include not quantifying morbidity from false positives or the impact of patient knowledge regarding early diagnosis.