title: Personalizing age of cancer screening cessation based on comorbid conditions: model estimates of harms and benefits.
abstract: BACKGROUND
  Harms and benefits of cancer screening depend on age and comorbid conditions, but reliable estimates are lacking.
  
  
  OBJECTIVE
  To estimate the harms and benefits of cancer screening by age and comorbid conditions to inform decisions about screening cessation.
  
  
  METHODS
  Collaborative modeling with 7 cancer simulation models and common data on average and comorbid condition level-specific life expectancy.
  
  
  METHODS
  U.S. population.
  
  
  METHODS
  U.S. cohorts aged 66 to 90 years in 2010 with average health or 1 of 4 comorbid condition levels: none, mild, moderate, or severe.
  
  
  METHODS
  Mammography, prostate-specific antigen testing, or fecal immunochemical testing.
  
  
  METHODS
  Lifetime cancer deaths prevented and life-years gained (benefits); false-positive test results and overdiagnosed cancer cases (harms). For each comorbid condition level, the age at which harms and benefits of screening were similar to that for persons with average health having screening at age 74 years.
  
  
  RESULTS
  Screening 1000 women with average life expectancy at age 74 years for breast cancer resulted in 79 to 96 (range across models) false-positive results, 0.5 to 0.8 overdiagnosed cancer cases, and 0.7 to 0.9 prevented cancer deaths. Although absolute numbers of harms and benefits differed across cancer sites, the ages at which to cease screening were consistent across models and cancer sites. For persons with no, mild, moderate, and severe comorbid conditions, screening until ages 76, 74, 72, and 66 years, respectively, resulted in harms and benefits similar to average-health persons.
  
  
  CONCLUSIONS
  Comorbid conditions influenced only life expectancy.
  
  
  CONCLUSIONS
  Comorbid conditions are an important determinant of harms and benefits of screening. Estimates of screening benefits and harms by comorbid condition can inform discussions between providers and patients about personalizing screening cessation decisions.
  
  
  BACKGROUND
  National Cancer Institute and Centers for Disease Control and Prevention.
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.forename: Roman
authors.initials: R
authors.lastname: Gulati
authors.forename: Angela B
authors.initials: AB
authors.lastname: Mariotto
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.forename: Tiago M
authors.initials: TM
authors.lastname: de Carvalho
authors.forename: Amy B
authors.initials: AB
authors.lastname: Knudsen
authors.forename: Nicolien T
authors.initials: NT
authors.lastname: van Ravesteyn
authors.forename: Eveline A M
authors.initials: EA
authors.lastname: Heijnsdijk
authors.forename: Chester
authors.initials: C
authors.lastname: Pabiniak
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Feuer
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Ann G
authors.initials: AG
authors.lastname: Zauber
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D015897:Comorbidity; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007610:Kallikreins / Q000097:blood; D008297:Male; D008327:Mammography; D008954:Models, Biological; D009780:Occult Blood; D057285:Precision Medicine; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D014481:United States
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen