Benefits, Harms, and Costs for Breast Cancer Screening After US Implementation of Digital Mammography

Stout, Natasha K.; Lee, Sandra J.; Schechter, Clyde B.; Kerlikowske, Karla; Alagöz, Oğuzhan; Berry, Donald A.; Buist, Diana S.M.; Çevik, Mücahit; Chisholm, Gary B.; Koning, Harry J. de; Huang, Hui; Hubbard, Rebecca A.; Miglioretti, Diana L.; Munsell, Mark F.; Trentham‐Dietz, Amy; Ravesteyn, Nicolien T. van; Tosteson, Anna N.A.; Mandelblatt, Jeanne S.

doi:10.1093/jnci/dju092

Cited by 124 publications

(108 citation statements)

References 39 publications

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“…[60][61][62] Based upon modelling of a transition from film to alldigital screening in the USA, Stout et al 63 estimate that digital screening contributes an additional 220 FPs per 1000 females above the FP incidence seen with the current mixed use of film and digital. It can be suggested that the rise in the FP rate following the transition to digital technology is actually associated with the use of computer-aided detection (CAD) image interpretation software rather than being attributed to factors inherent to the acquisition of images by digital mammographic units themselves.…”

Section: Screening Protocolmentioning

confidence: 99%

“…From a financial perspective, diagnostic follow-ups are estimated to cost anywhere from $134.80 USD for additional imaging to $1374.69 USD for invasive diagnostic testing per FP. 63 Although these harms are predominantly short term and are justified for patients in which progressive invasive cancer is detected, they are considered unjustified for those patients possessing true benign cases. Benign cases are defined as cases which do not require any intervention, nor are they any cause for concern.…”

Section: Risk-benefit Analysis Diagnostic Follow-upmentioning

confidence: 99%

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Is the false-positive rate in mammography in North America too high?

Le¹,

Mothersill²,

Seymour³

et al. 2016

BJR

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The practice of investigating pathological abnormalities in the breasts of females who are asymptomatic is primarily employed using X-ray mammography. The importance of breast screening is reflected in the mortality-based benefits observed among females who are found to possess invasive breast carcinoma prior to the manifestation of clinical symptoms. It is estimated that population-based screening constitutes a 17% reduction in the breast cancer mortality rate among females affected by invasive breast carcinoma. In spite of the significant utility that screening confers in those affected by invasive cancer, limitations associated with screening manifest as potential harms affecting individuals who are free of invasive disease. Disease-free and benign tumour-bearing individuals who are subjected to diagnostic work-up following a screening examination constitute a population of cases referred to as false positives (FPs). This article discusses factors contributing to the FP rate in mammography and extends the discussion to an assessment of the consequences associated with FP reporting. We conclude that the mammography FP rate in North America is in excess based upon the observation of overtreatment of in situ lesions and the disproportionate distribution of detriment and benefit among the population of individuals recalled for diagnostic work-up subsequent to screening. To address the excessive incidence of FPs in mammography, we investigate solutions that may be employed to remediate the current status of the FP rate. Subsequently, it can be suggested that improvements in the breast-screening protocol, medical litigation risk, image interpretation software and the implementation of image acquisition modalities that overcome superimposition effects are promising solutions.

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Section: Screening Protocolmentioning

confidence: 99%

Section: Risk-benefit Analysis Diagnostic Follow-upmentioning

confidence: 99%

Is the false-positive rate in mammography in North America too high?

Le¹,

Mothersill²,

Seymour³

et al. 2016

BJR

View full text Add to dashboard Cite

show abstract

“…3 The number of consultations after recall in the presence of screening is calculated by using the number of screen-detected cancers and a positive predictive value (PPV) of 30% 30 (ages 50-74) or 12% (ages [40][41][42][43][44][45][46][47][48][49]. The number of consultations after recall in the absence of screening is calculated by using the number of clinically detected cancers and a PPV of 58.3%.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Sankatsing

Heijnsdijk

Luijt

et al. 2015

Intl Journal of Cancer

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In the Netherlands, routine mammography screening starts at age 50. This starting age may have to be reconsidered because of the increasing breast cancer incidence among women aged 40 to 49 and the recent implementation of digital mammography. We assessed the cost-effectiveness of digital mammography screening that starts between age 40 and 49, using a microsimulation model. Women were screened before age 50, in addition to the current programme (biennial 50-74). Screening strategies varied in starting age (between 40 and 50) and frequency (annual or biennial). The numbers of breast cancers diagnosed, life-years gained (LYG) and breast cancer deaths averted were predicted and incremental cost-effectiveness ratios (ICERs) were calculated to compare screening scenarios. Biennial screening from age 50 to 74 (current strategy) was estimated to gain 157 life years per 1,000 women with lifelong follow-up, compared to a situation without screening, and cost e3,376/ LYG (3.5% discounted). Additional screening increased the number of LYG, compared to no screening, ranging from 168 to 242. The costs to generate one additional LYG (i.e., ICER), comparing a screening strategy to the less intensive alternative, were estimated at e5,329 (biennial 48-74 vs. current strategy), e7,628 (biennial 45-74 vs. biennial 48-74), e10,826 (biennial 40-74 vs. biennial 45-74) and e18,759 (annual 40-49 1 biennial 50-74 vs. biennial 40-74). Other strategies (49 1 biennial 50-74 and annual 45-49 1 biennial 50-74) resulted in less favourable ICERs. These findings show that extending the Dutch screening programme by screening between age 40 and 49 is cost-effective, particularly for biennial strategies.Breast cancer is the most commonly diagnosed form of cancer among women aged 30 and older in the Netherlands. 1 Mammography screening allows for early detection and early treatment of breast cancer, with the aim of averting breast cancer death. In the Netherlands, women aged 50 to 74 are invited biennially to screening. Various randomised controlled trials demonstrated a statistically significant breast cancer mortality reduction due to mammography screening in this age group. 2-4 Furthermore, Otto et al. 5,6 showed that the Dutch population-based screening programme is effective in reducing breast cancer mortality. The evidence for the benefit of mammography screening for younger women is less conclusive, 7-9 however, an effect for this age group is supported by several studies. Although the UK Age Trial showed a non-significant 17% reduction in breast cancer mortality, 9 a statistically significant breast cancer mortality reduction of 15% to 18% associated with screening for women aged 39 to 49 or 40 to 49 at entry was demonstrated by several meta-analyses of randomised controlled trials. [10][11][12][13] In addition, a recent Swedish observational study that compared breast cancer mortality rates between women aged 40 and 49 who were invited to screening and women who were not invited to screening demonstrated a 26% statistically significant br...

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“…Therefore, the adoption of digital mammography is likely driven primarily by something other than guidelines and has been attributed to the results of a clinical trial reports that showed superior sensitivity in digital mammography. 57 Recent analyses suggest that the small life expectancy increases may not warrant the higher costs and lower specificity of digital mammography. 57,58 Although the data do not show a costeffectiveness argument for transitioning to digital mammography, practical concerns may have driven the widespread shift observed in our analysis.…”

Section: Discussionmentioning

confidence: 99%

“…57 Recent analyses suggest that the small life expectancy increases may not warrant the higher costs and lower specificity of digital mammography. 57,58 Although the data do not show a costeffectiveness argument for transitioning to digital mammography, practical concerns may have driven the widespread shift observed in our analysis. For example, the labor-intensive process of generating and storing a film mammography and the elongated processing time play a significant role in patient throughput and the time to diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Medicare Cancer Screening in the Context of Clinical Guidelines

Maroongroge¹,

Yu²

2018

American Journal of Clinical Oncology

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Both the aggressiveness of screening guidelines and screening rates for the Medicare FFS population peaked and then declined from 2000 to 2012. However, guideline publications did not consistently precede utilization trend shifts. Technology adoption, practical and financial concerns, and patient preferences may have also contributed to the observed trends. Further research should be performed on the impact of multiple, conflicting guidelines in cancer screening.

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Benefits, Harms, and Costs for Breast Cancer Screening After US Implementation of Digital Mammography

Abstract: The transition to digital breast cancer screening in the United States increased total costs for small added health benefits. The value of digital mammography screening among women aged 40 to 49 years depends on women's preferences regarding false positives.

Cited by 124 publications

References 39 publications

Is the false-positive rate in mammography in North America too high?

Is the false-positive rate in mammography in North America too high?

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Medicare Cancer Screening in the Context of Clinical Guidelines

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