Toward optimal screening strategies for older women

Costs, benefits, and harms of breast cancer screening by age, biology, and health status

Jeanne S. Mandelblatt, Clyde B. Schechter, K. Robin Yabroff, William Lawrence, James Dignam, Martine Extermann, Sarah Fox, Gretchen Orosz, Rebecca Silliman, Jennifer Cullen, Lodovico Balducci

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

CONTEXT: Optimal ages of breast cancer screening cessation remain uncertain. OBJECTIVE: To evaluate screening policies based on age and quartiles of life expectancy (LE). DESIGN AND POPULATION: We used a stochastic model with proxies of age-dependent biology to evaluate the incremental U.S. societal costs and benefits of biennial screening from age 50 until age 70, 79, or lifetime. MAIN OUTCOME MEASURES: Discounted incremental costs per life years saved (LYS). RESULTS: Lifetime screening is expensive ($151,434 per LYS) if women have treatment and survival comparable to clinical trials (idealized); stopping at age 79 costs $82,063 per LYS. This latter result corresponds to costs associated with an LE of 9.5 years at age 79, a value expected for 75% of 79-year-olds, about 50% of 80-year-olds, and 25% of 85-year-olds. Using actual treatment and survival patterns, screening benefits are greater, and lifetime screening of all women might be considered ($114,905 per LYS), especially for women in the top 25% of LE for their age ($50,643 per LYS, life expectancy of ∼7 years at age 90). CONCLUSIONS: If all women receive idealized treatment, the benefits of mammography beyond age 79 are too low relative to their costs to justify continued screening. However, if treatment is not ideal, extending screening beyond age 79 could be considered, especially for women in the top 25% of life expectancy for their age.

Original languageEnglish (US)
Pages (from-to)487-496
Number of pages10
JournalJournal of General Internal Medicine
Volume20
Issue number6
DOIs
StatePublished - Jun 2005

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Life Expectancy
Early Detection of Cancer
Health Status
Cost-Benefit Analysis
Breast Neoplasms
Costs and Cost Analysis
Survival
Proxy
Mammography
Therapeutics
Clinical Trials

Keywords

  • Breast neoplasms
  • Cost-effectiveness
  • Elderly
  • Screening

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Toward optimal screening strategies for older women : Costs, benefits, and harms of breast cancer screening by age, biology, and health status. / Mandelblatt, Jeanne S.; Schechter, Clyde B.; Yabroff, K. Robin; Lawrence, William; Dignam, James; Extermann, Martine; Fox, Sarah; Orosz, Gretchen; Silliman, Rebecca; Cullen, Jennifer; Balducci, Lodovico.

In: Journal of General Internal Medicine, Vol. 20, No. 6, 06.2005, p. 487-496.

Research output: Contribution to journalArticle

Mandelblatt, JS, Schechter, CB, Yabroff, KR, Lawrence, W, Dignam, J, Extermann, M, Fox, S, Orosz, G, Silliman, R, Cullen, J & Balducci, L 2005, 'Toward optimal screening strategies for older women: Costs, benefits, and harms of breast cancer screening by age, biology, and health status', Journal of General Internal Medicine, vol. 20, no. 6, pp. 487-496. https://doi.org/10.1111/j.1525-1497.2005.0116.x
Mandelblatt, Jeanne S. ; Schechter, Clyde B. ; Yabroff, K. Robin ; Lawrence, William ; Dignam, James ; Extermann, Martine ; Fox, Sarah ; Orosz, Gretchen ; Silliman, Rebecca ; Cullen, Jennifer ; Balducci, Lodovico. / Toward optimal screening strategies for older women : Costs, benefits, and harms of breast cancer screening by age, biology, and health status. In: Journal of General Internal Medicine. 2005 ; Vol. 20, No. 6. pp. 487-496.
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abstract = "CONTEXT: Optimal ages of breast cancer screening cessation remain uncertain. OBJECTIVE: To evaluate screening policies based on age and quartiles of life expectancy (LE). DESIGN AND POPULATION: We used a stochastic model with proxies of age-dependent biology to evaluate the incremental U.S. societal costs and benefits of biennial screening from age 50 until age 70, 79, or lifetime. MAIN OUTCOME MEASURES: Discounted incremental costs per life years saved (LYS). RESULTS: Lifetime screening is expensive ($151,434 per LYS) if women have treatment and survival comparable to clinical trials (idealized); stopping at age 79 costs $82,063 per LYS. This latter result corresponds to costs associated with an LE of 9.5 years at age 79, a value expected for 75{\%} of 79-year-olds, about 50{\%} of 80-year-olds, and 25{\%} of 85-year-olds. Using actual treatment and survival patterns, screening benefits are greater, and lifetime screening of all women might be considered ($114,905 per LYS), especially for women in the top 25{\%} of LE for their age ($50,643 per LYS, life expectancy of ∼7 years at age 90). CONCLUSIONS: If all women receive idealized treatment, the benefits of mammography beyond age 79 are too low relative to their costs to justify continued screening. However, if treatment is not ideal, extending screening beyond age 79 could be considered, especially for women in the top 25{\%} of life expectancy for their age.",
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AU - Lawrence, William

AU - Dignam, James

AU - Extermann, Martine

AU - Fox, Sarah

AU - Orosz, Gretchen

AU - Silliman, Rebecca

AU - Cullen, Jennifer

AU - Balducci, Lodovico

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N2 - CONTEXT: Optimal ages of breast cancer screening cessation remain uncertain. OBJECTIVE: To evaluate screening policies based on age and quartiles of life expectancy (LE). DESIGN AND POPULATION: We used a stochastic model with proxies of age-dependent biology to evaluate the incremental U.S. societal costs and benefits of biennial screening from age 50 until age 70, 79, or lifetime. MAIN OUTCOME MEASURES: Discounted incremental costs per life years saved (LYS). RESULTS: Lifetime screening is expensive ($151,434 per LYS) if women have treatment and survival comparable to clinical trials (idealized); stopping at age 79 costs $82,063 per LYS. This latter result corresponds to costs associated with an LE of 9.5 years at age 79, a value expected for 75% of 79-year-olds, about 50% of 80-year-olds, and 25% of 85-year-olds. Using actual treatment and survival patterns, screening benefits are greater, and lifetime screening of all women might be considered ($114,905 per LYS), especially for women in the top 25% of LE for their age ($50,643 per LYS, life expectancy of ∼7 years at age 90). CONCLUSIONS: If all women receive idealized treatment, the benefits of mammography beyond age 79 are too low relative to their costs to justify continued screening. However, if treatment is not ideal, extending screening beyond age 79 could be considered, especially for women in the top 25% of life expectancy for their age.

AB - CONTEXT: Optimal ages of breast cancer screening cessation remain uncertain. OBJECTIVE: To evaluate screening policies based on age and quartiles of life expectancy (LE). DESIGN AND POPULATION: We used a stochastic model with proxies of age-dependent biology to evaluate the incremental U.S. societal costs and benefits of biennial screening from age 50 until age 70, 79, or lifetime. MAIN OUTCOME MEASURES: Discounted incremental costs per life years saved (LYS). RESULTS: Lifetime screening is expensive ($151,434 per LYS) if women have treatment and survival comparable to clinical trials (idealized); stopping at age 79 costs $82,063 per LYS. This latter result corresponds to costs associated with an LE of 9.5 years at age 79, a value expected for 75% of 79-year-olds, about 50% of 80-year-olds, and 25% of 85-year-olds. Using actual treatment and survival patterns, screening benefits are greater, and lifetime screening of all women might be considered ($114,905 per LYS), especially for women in the top 25% of LE for their age ($50,643 per LYS, life expectancy of ∼7 years at age 90). CONCLUSIONS: If all women receive idealized treatment, the benefits of mammography beyond age 79 are too low relative to their costs to justify continued screening. However, if treatment is not ideal, extending screening beyond age 79 could be considered, especially for women in the top 25% of life expectancy for their age.

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