title: Benefits and harms of mammography screening after age 74 years: model estimates of overdiagnosis.
abstract: BACKGROUND
  The aim of this study was to quantify the benefits and harms of mammography screening after age 74 years, focusing on the amount of overdiagnosis of invasive breast cancer and ductal carcinoma in situ (DCIS).
  
  
  METHODS
  Three well-established microsimulation models were used to simulate a cohort of American women born in 1960. All women received biennial screening starting at age 50 years with cessation ages varying from 74 up to 96 years. We estimated the number of life-years gained (LYG), quality-adjusted life-years, breast cancer deaths averted, false-positives, and overdiagnosed women per 1000 screens.
  
  
  RESULTS
  The models predicted that there were 7.8 to 11.4 LYG per 1000 screens at age 74 years (range across models), decreasing to 4.8 to 7.8 LYG per 1000 screens at age 80 years, and 1.4 to 2.4 LYG per 1000 screens at age 90 years. When adjusted for quality-of-life decrements, the LYG decreased by 5% to 13% at age 74 years and 11% to 22% at age 80 years. At age 90 to 92 years, all LYG were counterbalanced by a loss in quality-of-life, mainly because of the increasing number of overdiagnosed breast cancers per 1000 screens: 1.2 to 5.0 at age 74 years, 1.8 to 6.0 at age 80 years, and 3.7 to 7.5 at age 90 years. The age at which harms began to outweigh benefits shifted to a younger age when larger or longer utility losses because of a breast cancer diagnosis were assumed.
  
  
  CONCLUSIONS
  The balance between screening benefits and harms becomes less favorable after age 74 years. At age 90 years, harms outweigh benefits, largely as a consequence of overdiagnosis. This age was the same across the three models, despite important model differences in assumptions on DCIS.
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM). n.vanravesteyn@erasmusmc.nl.
authors.forename: Nicolien T
authors.initials: NT
authors.lastname: van Ravesteyn
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
authors.forename: Natasha K
authors.initials: NK
authors.lastname: Stout
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
authors.forename: Eveline A M
authors.initials: EA
authors.lastname: Heijnsdijk
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Alagoz
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
authors.forename: Amy
authors.initials: A
authors.lastname: Trentham-Dietz
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
mesh_terms: D017677:Age Distribution; D000368:Aged; D000375:Aging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000009:adverse effects*; D008403:Mass Screening / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D015233:Models, Statistical; D019057:Quality-Adjusted Life Years; D018426:SEER Program; D014481:United States / Q000453:epidemiology