Modeling the impact of population screening on breast cancer mortality in the United States.
OBJECTIVE
Optimal US screening strategies remain controversial. We use six simulation models to evaluate screening outcomes under varying strategies.


METHODS
The models incorporate common data on incidence, mammography characteristics, and treatment effects. We evaluate varying initiation and cessation ages applied annually or biennially and calculate mammograms, mortality reduction (vs. no screening), false-positives, unnecessary biopsies and over-diagnosis.


RESULTS
The lifetime risk of breast cancer death starting at age 40 is 3% and is reduced by screening. Screening biennially maintains 81% (range 67% to 99%) of annual screening benefits with fewer false-positives. Biennial screening from 50-74 reduces the probability of breast cancer death from 3% to 2.3%. Screening annually from 40 to 84 only lowers mortality an additional one-half of one percent to 1.8% but requires substantially more mammograms and yields more false-positives and over-diagnosed cases.


CONCLUSIONS
Decisions about screening strategy depend on preferences for benefits vs. potential harms and resource considerations.
Department of Oncology and Medicine, Georgetown University Medical Center and Cancer Control Program, Lombardi Comprehensive Cancer Center, 3300 Whitehaven St, NW, Suite 4100, Washington, DC 20007, USA. mandelbj@georgetown.edu
Jeanne S
JS
Mandelblatt
Kathleen A
KA
Cronin
Donald A
DA
Berry
Yaojen
Y
Chang
Harry J
HJ
de Koning
Sandra J
SJ
Lee
Sylvia K
SK
Plevritis
Clyde B
CB
Schechter
Natasha K
NK
Stout
Nicolien T
NT
van Ravesteyn
Marvin
M
Zelen
Eric J
EJ
Feuer
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D055088:Early Detection of Cancer / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000401:mortality / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000401:mortality / Q000706:statistics & numerical data*; D008875:Middle Aged; D015233:Models, Statistical; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014481:United States