TY - JOUR
T1 - Toward optimal screening strategies for older women
T2 - Costs, benefits, and harms of breast cancer screening by age, biology, and health status
AU - Mandelblatt, Jeanne S.
AU - Schechter, Clyde B.
AU - Yabroff, K. Robin
AU - Lawrence, William
AU - Dignam, James
AU - Extermann, Martine
AU - Fox, Sarah
AU - Orosz, Gretchen
AU - Silliman, Rebecca
AU - Cullen, Jennifer
AU - Balducci, Lodovico
N1 - Funding Information:
This work was supported by grants K05 CA96940 (JSM) and RO1 CA72908 (JSM, KRY, CBS) and cooperative agreement UO1-CA88293A from the National Cancer Institute (JSM, JC, WL, CBS).
PY - 2005/6
Y1 - 2005/6
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.
KW - Breast neoplasms
KW - Cost-effectiveness
KW - Elderly
KW - Screening
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U2 - 10.1111/j.1525-1497.2005.0116.x
DO - 10.1111/j.1525-1497.2005.0116.x
M3 - Article
C2 - 15987322
AN - SCOPUS:22344436099
SN - 0884-8734
VL - 20
SP - 487
EP - 496
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 6
ER -