title: Screening outcomes in older US women undergoing multiple mammograms in community practice: does interval, age, or comorbidity score affect tumor characteristics or false positive rates?
abstract: Background Uncertainty exists about the appropriate use of screening mammography among older women because comorbid illnesses may diminish the benefit of screening. We examined the risk of adverse tumor characteristics and false positive rates according to screening interval, age, and comorbidity. Methods From January 1999 to December 2006, data were collected prospectively on 2993 older women with breast cancer and 137 949 older women without breast cancer who underwent mammography at facilities that participated in a data linkage between the Breast Cancer Surveillance Consortium and Medicare claims. Women were aged 66 to 89 years at study entry to allow for measurement of 1 year of preexisting illnesses. We used logistic regression analyses to calculate the odds of advanced (IIb, III, IV) stage, large (>20 millimeters) tumors, and 10-year cumulative probability of false-positive mammography by screening frequency (1 vs 2 years), age, and comorbidity score. The comorbidity score was derived using the Klabunde approximation of the Charlson score. All statistical tests were two-sided. Results Adverse tumor characteristics did not differ statistically significantly by comorbidity, age, or interval. Cumulative probability of a false-positive mammography result was higher among annual screeners than biennial screeners irrespective of comorbidity: 48.0% (95% confidence interval [CI] = 46.1% to 49.9%) of annual screeners aged 66 to 74 years had a false-positive result compared with 29.0% (95% CI = 28.1% to 29.9%) of biennial screeners. Conclusion Women aged 66 to 89 years who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of a false-positive recommendation than annual screeners, regardless of comorbidity.
authors: Department of Epidemiology and Biostatistics, University of California, San Francisco, 185 Berry St, Ste 5700, San Francisco, CA 94107, USA. DBraithwaite@epi.ucsf.edu
authors: Dejana
authors: D
authors: Braithwaite
authors: Weiwei
authors: W
authors: Zhu
authors: Rebecca A
authors: RA
authors: Hubbard
authors: Ellen S
authors: ES
authors: O'Meara
authors: Diana L
authors: DL
authors: Miglioretti
authors: Berta
authors: B
authors: Geller
authors: Kim
authors: K
authors: Dittus
authors: Dan
authors: D
authors: Moore
authors: Karen J
authors: KJ
authors: Wernli
authors: Jeanne
authors: J
authors: Mandelblatt
authors: Karla
authors: K
authors: Kerlikowske
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D003153:Community Health Services / Q000379:methods / Q000592:standards; D015897:Comorbidity; D055088:Early Detection of Cancer / Q000379:methods; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D006278:Medicare; D009367:Neoplasm Staging; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D012111:Residence Characteristics; D018426:SEER Program; D013997:Time Factors; D014481:United States / Q000453:epidemiology
references: AJR Am J Roentgenol. 1997 Oct;169(4):1001-8
references: 9308451
references: Med Care. 2005 Feb;43(2):132-40
references: 15655426
references: J Clin Oncol. 2009 Apr 10;27(11):1774-80
references: 19255318
references: J Am Geriatr Soc. 2002 Jun;50(6):1061-8
references: 12110066
references: JAMA. 2001 Feb 21;285(7):885-92
references: 11180731
references: J Natl Cancer Inst. 2004 Dec 15;96(24):1832-9
references: 15601639
references: J Natl Cancer Inst. 2006 May 17;98(10):660-1
references: 16705114
references: Breast Cancer Res Treat. 2012 Feb;131(3):1013-20
references: 22002567
references: JAMA. 2001 Jun 6;285(21):2750-6
references: 11386931
references: Ann Intern Med. 2009 Nov 17;151(10):716-26, W-236
references: 19920272
references: J Clin Epidemiol. 1997 Jun;50(6):725-33
references: 9250271
references: J Am Geriatr Soc. 2002 Oct;50(10):1651-8
references: 12366618
references: J Am Geriatr Soc. 2004 Oct;52(10):1688-95
references: 15450046
references: Arch Intern Med. 2011 Dec 12;171(22):2031-7
references: 22158573
references: CA Cancer J Clin. 2010 Mar-Apr;60(2):99-119
references: 20228384
references: J Gerontol A Biol Sci Med Sci. 2000 Oct;55(10):M593-600
references: 11034232
references: Ann Intern Med. 2009 Nov 17;151(10):738-47
references: 19920274
references: Cancer. 2011 Jul 15;117(14):3252-61
references: 21246529
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: JAMA. 1995 Jan 11;273(2):149-54
references: 7799496
references: N Engl J Med. 1998 Apr 16;338(16):1089-96
references: 9545356
references: J Clin Oncol. 2008 May 20;26(15):2482-8
references: 18427152
references: J Clin Epidemiol. 2000 Dec;53(12):1258-67
references: 11146273
references: J Gen Intern Med. 2005 Jun;20(6):487-96
references: 15987322
references: Biometrics. 2004 Sep;60(3):651-60
references: 15339287
references: J Clin Oncol. 2009 Dec 10;27(35):5919-23
references: 19884547
references: Stat Methods Med Res. 2010 Oct;19(5):429-49
references: 20356857
references: Med Care. 2006 May;44(5):463-70
references: 16641665
references: Ann Epidemiol. 2007 Aug;17(8):584-90
references: 17531502
references: Prev Med. 1999 Apr;28(4):418-25
references: 10090871
references: Med Care. 2006 Oct;44(10):921-8
references: 17001263
references: Ann Intern Med. 1992 May 1;116(9):722-30
references: 1558343
references: J Clin Epidemiol. 1994 Nov;47(11):1245-51
references: 7722560