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Kregting LM, van Ravesteyn NT, Chootipongchaivat S, Heijnsdijk EAM, Otten JDM, Broeders MJM, de Koning HJ. Cumulative risks of false positive recall and screen-detected breast cancer after multiple screening examinations. Int J Cancer 2023; 153:312-319. [PMID: 37038266 DOI: 10.1002/ijc.34530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
Women tend to make a decision about participation in breast cancer screening and adhere to this for future invitations. Therefore, our study aimed to provide high-quality information on cumulative risks of false-positive (FP) recall and screen-detected breast cancer over multiple screening examinations. Individual Dutch screening registry data (2005-2018) were gathered on subsequent screening examinations of 92 902 women age 49 to 51 years in 2005. Survival analyses were used to calculate cumulative risks of a FP and a true-positive (TP) result after seven examinations. Data from 66 472 women age 58 to 59 years were used to extrapolate to 11 examinations. Participation, detection and additional FP rates were calculated for women who previously received FP results compared to women with true negative (TN) results. After 7 examinations, the cumulative risk of a TP result was 3.7% and the cumulative risk of a FP result was 9.1%. After 11 examinations, this increased to 7.1% and 13.5%, respectively. Following a FP result, participation was lower (71%-81%) than following a TN result (>90%). In women with a FP result, more TP results (factor 1.59 [95% CI: 1.44-1.72]), more interval cancers (factor 1.66 [95% CI: 1.41-1.91]) and more FP results (factor 1.96 [95% CI: 1.87-2.05]) were found than in women with TN results. In conclusion, due to a low recall rate in the Netherlands, the cumulative risk of a FP recall is relatively low, while the cumulative risk of a TP result is comparable. Breast cancer diagnoses and FP results were more common in women with FP results than in women with TN results, while participation was lower.
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Affiliation(s)
- Lindy M Kregting
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sarocha Chootipongchaivat
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Mireille J M Broeders
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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2
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Canelo-Aybar C, Ferreira DS, Ballesteros M, Posso M, Montero N, Solà I, Saz-Parkinson Z, Lerda D, Rossi PG, Duffy SW, Follmann M, Gräwingholt A, Alonso-Coello P. Benefits and harms of breast cancer mammography screening for women at average risk of breast cancer: A systematic review for the European Commission Initiative on Breast Cancer. J Med Screen 2021; 28:389-404. [PMID: 33632023 DOI: 10.1177/0969141321993866] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Mammography screening is generally accepted in women aged 50-69, but the balance between benefits and harms remains controversial in other age groups. This study systematically reviews these effects to inform the European Breast Cancer Guidelines. METHODS We searched PubMed, EMBASE and Cochrane Library for randomised clinical trials (RCTs) or systematic reviews of observational studies in the absence of RCTs comparing invitation to mammography screening to no invitation in women at average breast cancer (BC) risk. We extracted data for mortality, BC stage, mastectomy rate, chemotherapy provision, overdiagnosis and false-positive-related adverse effects. We performed a pooled analysis of relative risks, applying an inverse-variance random-effects model for three age groups (<50, 50-69 and 70-74). GRADE (Grading of Recommendations Assessment, Development and Evaluation) was used to assess the certainty of evidence. RESULTS We identified 10 RCTs including 616,641 women aged 38-75. Mammography reduced BC mortality in women aged 50-69 (relative risk (RR) 0.77, 95%CI (confidence interval) 0.66-0.90, high certainty) and 70-74 (RR 0.77, 95%CI 0.54-1.09, high certainty), with smaller reductions in under 50s (RR 0.88, 95%CI 0.76-1.02, moderate certainty). Mammography reduced stage IIA+ in women 50-69 (RR 0.80, 95%CI 0.64-1.00, very low certainty) but resulted in an overdiagnosis probability of 23% (95%CI 18-27%) and 17% (95%CI 15-20%) in under 50s and 50-69, respectively (moderate certainty). Mammography was associated with 2.9% increased risk of invasive procedures with benign outcomes (low certainty). CONCLUSIONS For women 50-69, high certainty evidence that mammography screening reduces BC mortality risk would support policymakers formulating strong recommendations. In other age groups, where the net balance of effects is less clear, conditional recommendations will be more likely, together with shared decision-making.
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Affiliation(s)
- Carlos Canelo-Aybar
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Diogenes S Ferreira
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mónica Ballesteros
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Margarita Posso
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Nadia Montero
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ivan Solà
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Donata Lerda
- European Commission, Joint Research Centre (JRC), Ispra, VA, Italy
| | - Paolo G Rossi
- Epidemiology Unit, AUSL - IRCCS di Reggio Emilia, RE, Italy
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | | | - Pablo Alonso-Coello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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3
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Hamashima C, Hamashima C C, Hattori M, Honjo S, Kasahara Y, Katayama T, Nakai M, Nakayama T, Morita T, Ohta K, Ohnuki K, Sagawa M, Saito H, Sasaki S, Shimada T, Sobue T, Suto A. The Japanese Guidelines for Breast Cancer Screening. Jpn J Clin Oncol 2016; 46:482-492. [PMID: 27207993 DOI: 10.1093/jjco/hyw008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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4
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Ripping TM, Hubbard RA, Otten JDM, den Heeten GJ, Verbeek ALM, Broeders MJM. Towards personalized screening: Cumulative risk of breast cancer screening outcomes in women with and without a first-degree relative with a history of breast cancer. Int J Cancer 2015; 138:1619-25. [PMID: 26537645 DOI: 10.1002/ijc.29912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/29/2015] [Indexed: 12/29/2022]
Abstract
Several reviews have estimated the balance of benefits and harms of mammographic screening in the general population. The balance may, however, differ between individuals with and without family history. Therefore, our aim is to assess the cumulative risk of screening outcomes; screen-detected breast cancer, interval cancer, and false-positive results, in women screenees aged 50-75 and 40-75, with and without a first-degree relative with a history of breast cancer at the start of screening. Data on screening attendance, recall and breast cancer detection were collected for each woman living in Nijmegen (The Netherlands) since 1975. We used a discrete time survival model to calculate the cumulative probability of each major screening outcome over 19 screening rounds. Women with a family history of breast cancer had a higher risk of all screening outcomes. For women screened from age 50-75, the cumulative risk of screen-detected breast cancer, interval cancer and false-positive results were 9.0, 4.4 and 11.1% for women with a family history and 6.3, 2.7 and 7.3% for women without a family history, respectively. The results for women 40-75 followed the same pattern for women screened 50-75 for cancer outcomes, but were almost doubled for false-positive results. To conclude, women with a first-degree relative with a history of breast cancer are more likely to experience benefits and harms of screening than women without a family history. To complete the balance and provide risk-based screening recommendations, the breast cancer mortality reduction and overdiagnosis should be estimated for family history subgroups.
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Affiliation(s)
- Theodora Maria Ripping
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Johannes D M Otten
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gerard J den Heeten
- Dutch Reference Centre for Screening, Nijmegen, the Netherlands.,Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - André L M Verbeek
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mireille J M Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.,Dutch Reference Centre for Screening, Nijmegen, the Netherlands
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5
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Li J, Shao Z. Mammography screening in less developed countries. SPRINGERPLUS 2015; 4:615. [PMID: 26543750 PMCID: PMC4627993 DOI: 10.1186/s40064-015-1394-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/05/2015] [Indexed: 12/29/2022]
Abstract
Less developed countries (LDCs) are struggling with an increasing burden of breast cancer. It is important to identify what interventions might be most effective and feasible in reducing overall breast cancer mortality in a resource constrained settings. Mammography screening (MS) utilized in developed countries cannot be equally applied to LDCs. We provide a summary of the status of existing and past MS program attempts in LDCs, and try to determine the prerequisites under which any developing country is ready to benefit from a MS program. We make the case for a “mixed” portfolio of tools to reduce breast cancer mortality with MS reserved only for those sub-populations that meet the criteria. We hope our review will provide a background for policy makers to apply rigorous criteria before attempting to implement costly MS program and before judiciously evaluating additional competed programs in their countries.
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Affiliation(s)
- JunJie Li
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - ZhiMin Shao
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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6
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Comparison of cumulative false-positive risk of screening mammography in the United States and Denmark. Cancer Epidemiol 2015; 39:656-63. [PMID: 26013768 DOI: 10.1016/j.canep.2015.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/04/2015] [Accepted: 05/10/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In the United States (US), about one-half of women screened with annual mammography have at least one false-positive test after ten screens. The estimate for European women screened ten times biennially is much lower. We evaluate to what extent screening interval, mammogram type, and statistical methods, can explain the reported differences. METHODS We included all screens from women first screened at age 50-69 years in the US Breast Cancer Surveillance Consortium (BCSC) (n=99,455) between 1996-2010, and from two population-based mammography screening programs in Denmark (n=230,452 and n=400,204), between 1991-2012 and 1993-2013, respectively. Model-based cumulative false-positive risks were computed for the entire sample, using two statistical methods (Hubbard Njor) previously used to estimate false-positive risks in the US and Europe. RESULTS Empirical cumulative risk of at least one false-positive test after eight (annual or biennial) screens was 41.9% in BCSC, 16.1% in Copenhagen, and 7.4% in Funen. Variation in screening interval and mammogram type did not explain the differences by country. Using the Hubbard method, the model-based cumulative risks after eight screens was 45.1% in BCSC, 9.6% in Copenhagen, and 8.8% in Funen. Using the Njor method, these risks were estimated to be 43.6, 10.9 and 8.0%. CONCLUSION Choice of statistical method, screening interval and mammogram type does not explain the substantial differences in cumulative false-positive risk between the US and Europe.
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Barco I, Chabrera C, García Font M, Gimenez N, Fraile M, Lain JM, Piqueras M, Vidal MC, Torras M, González S, Pessarrodona A, Barco J, Cassadó J, García Fernández A. Comparison of Screened and Nonscreened Breast Cancer Patients in Relation to Age: A 2-Institution Study. Clin Breast Cancer 2015; 15:482-9. [PMID: 25986958 DOI: 10.1016/j.clbc.2015.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 04/02/2015] [Accepted: 04/16/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Screening programs for breast cancer aim to allow early diagnosis, and thus reduce mortality. The aim of this study was to assess the effect of a population screening program in a sample of women aged between 50 and 69 years in terms of recurrence, metastasis, biological profiles, and survival, and to compare their results with those of women of a wider age range who did not participate on the screening program. PATIENTS AND METHODS A prospective multicenter study in which 1821 patients with 1873 breast tumors who received surgery between 1999 and 2014 at MútuaTerrassa University Hospital and the Hospital of Terrassa in Barcelona were analyzed. A comparison was performed in the 50- to 69-year-old age group between those who participated on the screening program and those who did not. RESULTS The mean age of patients was 58 years. The mean follow-up was 72 months, and median follow-up 59 months. The screened group showed significantly better results in all prognostic factors and in specific mortality than all nonscreened groups. The specific mortality rate in the screened patients was 2.4% (12/496), local recurrence 2.8% (14/496), and metastasis at 10 years 3.6% (18/496). In the nonscreened group, younger women presented a higher rate of metastasis (16.4% [81/493]) and a shorter disease-free period (77.1% [380/493]). The age group older than 70 years had the highest number of T4 tumors (7.5% [30/403]) and the highest proportion of radical surgery (50.4% [203/403]). CONCLUSION Patients in the screening program presented improved survival. We speculate that extending breast cancer screening programs to women younger than 50 and older than 70 years could bring about mortality benefits.
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Affiliation(s)
- Israel Barco
- Department of Gynaecology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Carol Chabrera
- Department of Nursing, School of Health Science Tecnocampus Mataró-Maresme, Barcelona, Spain
| | | | - Nuria Gimenez
- Research Unit, Research Foundation Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain; Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Manel Fraile
- Department of Nuclear Medicine (CTD), Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Josep María Lain
- Breast Unit, Department of Gynaecology, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Merce Piqueras
- Department of Gynaecology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - M Carmen Vidal
- Department of Nursing, Breastfeeding Promotion Programme, ASSIR Mollet, Institut Català de la Salut, Barcelona, Spain
| | - Merce Torras
- Department of Nursing, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Sonia González
- Department of Oncology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Pessarrodona
- Department of Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Josep Barco
- Department of Gynaecology and Obstetrics, Clínica Sant Josep, Manresa, Spain
| | - Jordi Cassadó
- Department of Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Antonio García Fernández
- Department of Gynaecology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain; Breast Cancer Screening Unit, Vallès Occidental, Institut Català de la Salut, Terrassa, Barcelona, Spain
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8
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Lee EH, Park B, Kim NS, Seo HJ, Ko KL, Min JW, Shin MH, Lee K, Lee S, Choi N, Hur MH, Kim DI, Kim MJ, Kim SY, Sunwoo S, Dang JY, Kim SY, Kim Y, Lee WC, Jeong J. The Korean guideline for breast cancer screening. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.5.408] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Eun Hye Lee
- Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Boyoung Park
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Nam-Soon Kim
- Health Policy Research Department, Korea Institute for Health and Social Affairs, Sejong, Korea
| | - Hyun-Ju Seo
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Kyoung Lan Ko
- Department of Radiology, Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Jun Won Min
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Kiheon Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seeyoun Lee
- Department of Surgery, Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Nami Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University College of Medicine, Seoul, Korea
| | - Min Hee Hur
- Department of Surgery, Cheil General Hospital & Women's Healthcare Center, Dankook Universitiy College of Medicine, Seoul, Korea
| | - Dong Il Kim
- Department of Environmental and Occupational Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Yong Kim
- Department of Surgery, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Sung Sunwoo
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeon Dang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Soo Young Kim
- Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Won-Chul Lee
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Toward the breast screening balance sheet: cumulative risk of false positives for annual versus biennial mammograms commencing at age 40 or 50. Breast Cancer Res Treat 2014; 149:211-21. [DOI: 10.1007/s10549-014-3226-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 12/01/2014] [Indexed: 11/25/2022]
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10
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Leung J, McKenzie S, Martin J, Dobson A, McLaughlin D. Longitudinal Patterns of Breast Cancer Screening: Mammography, Clinical, and Breast Self-Examinations in a Rural and Urban Setting. Womens Health Issues 2014; 24:e139-46. [DOI: 10.1016/j.whi.2013.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 11/27/2022]
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11
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Melnikow J, Tancredi DJ, Yang Z, Ritley D, Jiang Y, Slee C, Popova S, Rylett P, Knutson K, Smalley S. Program-specific cost-effectiveness analysis: breast cancer screening policies for a safety-net program. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:932-941. [PMID: 24041343 DOI: 10.1016/j.jval.2013.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 05/27/2013] [Accepted: 06/03/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Every Woman Counts (EWC), a California breast cancer screening program, faced challenging budget cutbacks and policy choices. METHODS A microsimulation model evaluated costs, outcomes, and cost-effectiveness of EWC program mammography policy options on coverage for digital mammography (which has a higher cost than film mammography but recent legislation allowed reimbursement at the lower film rate); screening eligibility age; and screening frequency. Model inputs were based on analyses of program claims data linked to California Cancer Registry data, Surveillance, Epidemiology, and End Results data, and the Medi-Cal literature. Outcomes included number of procedures, cancers, cancer deaths, costs, and incremental cost per life-year. RESULTS Projected model outcomes matched program data closely. With restrictions on the number of clients screened, strategies starting screening at age 40 years were dominated (not cost-effective). This finding was highly robust in sensitivity analyses. Compared with no screening, biennial film mammography for women aged 50 to 64 years was projected to reduce 15-year breast cancer mortality by nearly 7.8% at $18,999 per additional life-year, annual film mammography was $106,428 per additional life-year, and digital mammography $180,333 per additional life-year. This more effective, more expensive strategy was projected to reduce breast cancer mortality by 8.6%. Under equal mammography reimbursement, biennial digital mammography beginning at age 50 years was projected to decrease 15-year breast cancer mortality by 8.6% at an incremental cost per additional life-year of $17,050. CONCLUSIONS For the EWC program, biennial screening mammography starting at age 50 years was the most cost-effective strategy. The impact of digital mammography on life expectancy was small. Program-specific cost-effectiveness analysis can be completed in a policy-relevant time frame to assist policymakers faced with difficult program choices.
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Affiliation(s)
- Joy Melnikow
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA.
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12
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Inequalities in uptake of breast cancer screening in Spain: analysis of a cross-sectional national survey. Public Health 2013; 127:822-7. [DOI: 10.1016/j.puhe.2013.03.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 11/30/2012] [Accepted: 03/23/2013] [Indexed: 01/31/2023]
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13
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Situación de la investigación en el cribado de cáncer de mama en España: implicaciones para la prevención. GACETA SANITARIA 2012; 26:574-81. [DOI: 10.1016/j.gaceta.2011.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 11/15/2011] [Accepted: 11/16/2011] [Indexed: 11/19/2022]
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14
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Hofvind S, Ponti A, Patnick J, Ascunce N, Njor S, Broeders M, Giordano L, Frigerio A, Törnberg S. False-Positive Results in Mammographic Screening for Breast Cancer in Europe: A Literature Review and Survey of Service Screening Programmes. J Med Screen 2012; 19 Suppl 1:57-66. [PMID: 22972811 DOI: 10.1258/jms.2012.012083] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Solveig Hofvind
- Researcher, Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Antonio Ponti
- Epidemiologist, Epidemiology Unit, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
| | | | - Nieves Ascunce
- Public Health Doctor, Navarra Breast Cancer Screening Programme. Spanish Cancer Screening Network, Public Health Institute, Pamplona, Spain
| | - Sisse Njor
- Post Doc, Centre for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - Mireille Broeders
- Senior Epidemiologist, Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, and National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands
| | - Livia Giordano
- MD MPH, Epidemiologist, Epidemiology Unit, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
| | - Alfonso Frigerio
- Radiologist, Regional Reference Centre for Breast Cancer Screening, AOU S. Giovanni Battista, Turin, Italy
| | - Sven Törnberg
- Oncologist and Director, Cancer Screening Unit, Oncologic Centre S3:00, Karolinska University Hospital, Stockholm, Sweden
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15
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Miller AB. Breast cancer screening: commentary and conclusions. Prev Med 2011; 53:147-8. [PMID: 21911177 DOI: 10.1016/j.ypmed.2011.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 08/15/2011] [Accepted: 08/16/2011] [Indexed: 11/16/2022]
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