title: Collaborative Modeling of the Benefits and Harms Associated With Different U.S. Breast Cancer Screening Strategies.
abstract: BACKGROUND
  Controversy persists about optimal mammography screening strategies.
  
  
  OBJECTIVE
  To evaluate screening outcomes, taking into account advances in mammography and treatment of breast cancer.
  
  
  METHODS
  Collaboration of 6 simulation models using national data on incidence, digital mammography performance, treatment effects, and other-cause mortality.
  
  
  METHODS
  United States.
  
  
  METHODS
  Average-risk U.S. female population and subgroups with varying risk, breast density, or comorbidity.
  
  
  METHODS
  Eight strategies differing by age at which screening starts (40, 45, or 50 years) and screening interval (annual, biennial, and hybrid [annual for women in their 40s and biennial thereafter]). All strategies assumed 100% adherence and stopped at age 74 years.
  
  
  METHODS
  Benefits (breast cancer-specific mortality reduction, breast cancer deaths averted, life-years, and quality-adjusted life-years); number of mammograms used; harms (false-positive results, benign biopsies, and overdiagnosis); and ratios of harms (or use) and benefits (efficiency) per 1000 screens.
  
  
  RESULTS
  Biennial strategies were consistently the most efficient for average-risk women. Biennial screening from age 50 to 74 years avoided a median of 7 breast cancer deaths versus no screening; annual screening from age 40 to 74 years avoided an additional 3 deaths, but yielded 1988 more false-positive results and 11 more overdiagnoses per 1000 women screened. Annual screening from age 50 to 74 years was inefficient (similar benefits, but more harms than other strategies). For groups with a 2- to 4-fold increased risk, annual screening from age 40 years had similar harms and benefits as screening average-risk women biennially from 50 to 74 years. For groups with moderate or severe comorbidity, screening could stop at age 66 to 68 years.
  
  
  CONCLUSIONS
  Other imaging technologies, polygenic risk, and nonadherence were not considered.
  
  
  CONCLUSIONS
  Biennial screening for breast cancer is efficient for average-risk populations. Decisions about starting ages and intervals will depend on population characteristics and the decision makers' weight given to the harms and benefits of screening.
  
  
  BACKGROUND
  National Institutes of Health.
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
authors.forename: Natasha K
authors.initials: NK
authors.lastname: Stout
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: van den Broek
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.forename: Martin
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authors.lastname: Krapcho
authors.forename: Amy
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authors.lastname: Trentham-Dietz
authors.forename: Diego
authors.initials: D
authors.lastname: Munoz
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Donald A
authors.initials: DA
authors.lastname: Berry
authors.forename: Nicolien T
authors.initials: NT
authors.lastname: van Ravesteyn
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Alagoz
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: Aimee M
authors.initials: AM
authors.lastname: Near
authors.forename: Amanda
authors.initials: A
authors.lastname: Hoeffken
authors.forename: Yaojen
authors.initials: Y
authors.lastname: Chang
authors.forename: Eveline A
authors.initials: EA
authors.lastname: Heijnsdijk
authors.forename: Gary
authors.initials: G
authors.lastname: Chisholm
authors.forename: Xuelin
authors.initials: X
authors.lastname: Huang
authors.forename: Hui
authors.initials: H
authors.lastname: Huang
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Ergun
authors.forename: Ronald
authors.initials: R
authors.lastname: Gangnon
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
authors.forename: Sylvia
authors.initials: S
authors.lastname: Plevritis
authors.forename: Eric
authors.initials: E
authors.lastname: Feuer
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Cronin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001940:Breast / Q000033:anatomy & histology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D003198:Computer Simulation; D055088:Early Detection of Cancer / Q000009:adverse effects* / Q000379:methods; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000009:adverse effects* / Q000379:methods; D008403:Mass Screening / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D018570:Risk Assessment; D013997:Time Factors; D014481:United States / Q000453:epidemiology