title: Estimated effects of the National Breast and Cervical Cancer Early Detection Program on breast cancer mortality.
abstract: BACKGROUND
  The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast cancer screening to medically underserved, low-income women aged 40-64 years. No study has evaluated NBCCEDP's effect on breast cancer mortality.
  
  
  OBJECTIVE
  This study estimates life-years saved by NBCCEDP breast cancer screening compared with screening in the absence of NBCCEDP and with no screening.
  
  
  METHODS
  A breast cancer simulation model based on existing Cancer Intervention and Surveillance Modeling Network models was constructed. The screening module from these models was modified to reflect screening frequency for NBCCEDP participants. Screening data for uninsured women represented what would have happened without the program. Separate simulations were performed for women who received NBCCEDP (Program) screening, women who potentially received screening without the program (No Program), and women who received no screening (No Screening). The impact of NBCCEDP was estimated as the difference in life-years between the Program and No Program, and the Program and No Screening scenarios. The analysis was performed in 2008-2009.
  
  
  RESULTS
  Among 1.8 million women who were screened between 1991 and 2006, the Program saved 100,800 life-years compared with No Program and 369,000 life-years compared with No Screening. Per woman screened, the Program saved 0.056 life-years (95% CI=0.031, 0.081) compared with No Program and 0.206 life-years (95% CI=0.177, 0.234) compared with No Screening. Per woman with invasive breast cancer and screen-detected invasive cancer, the Program saved 0.41 and 0.71 life-years, respectively, compared with No Program.
  
  
  CONCLUSIONS
  These estimates suggest that NBCCEDP breast cancer screening has reduced mortality among medically uninsured and underinsured low-income women.
authors.affiliation: Research Triangle Institute International, Research Triangle Park, North Carolina, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hoerger
authors.forename: Donatus U
authors.initials: DU
authors.lastname: Ekwueme
authors.forename: Jacqueline W
authors.initials: JW
authors.lastname: Miller
authors.forename: Vladislav
authors.initials: V
authors.lastname: Uzunangelov
authors.forename: Ingrid J
authors.initials: IJ
authors.lastname: Hall
authors.forename: Joel
authors.initials: J
authors.lastname: Segel
authors.forename: Janet
authors.initials: J
authors.lastname: Royalty
authors.forename: James G
authors.initials: JG
authors.lastname: Gardner
authors.forename: Judith Lee
authors.initials: JL
authors.lastname: Smith
authors.forename: Chunyu
authors.initials: C
authors.lastname: Li
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality; D003198:Computer Simulation; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D011203:Poverty; D014481:United States