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Tailoring Breast Cancer Screening Intervals by Breast Density and Risk for Women Aged 50 Years or Older: Collaborative Modeling of Screening Outcomes.

ABSTRACT: Background:Biennial screening is generally recommended for average-risk women aged 50 to 74 years, but tailored screening may provide greater benefits. Objective:To estimate outcomes for various screening intervals after age 50 years based on breast density and risk for breast cancer. Design:Collaborative simulation modeling using national incidence, breast density, and screening performance data. Setting:United States. Patients:Women aged 50 years or older with various combinations of breast density and relative risk (RR) of 1.0, 1.3, 2.0, or 4.0. Intervention:Annual, biennial, or triennial digital mammography screening from ages 50 to 74 years (vs. no screening) and ages 65 to 74 years (vs. biennial digital mammography from ages 50 to 64 years). Measurements:Lifetime breast cancer deaths, life expectancy and quality-adjusted life-years (QALYs), false-positive mammograms, benign biopsy results, overdiagnosis, cost-effectiveness, and ratio of false-positive results to breast cancer deaths averted. Results:Screening benefits and overdiagnosis increase with breast density and RR. False-positive mammograms and benign results on biopsy decrease with increasing risk. Among women with fatty breasts or scattered fibroglandular density and an RR of 1.0 or 1.3, breast cancer deaths averted were similar for triennial versus biennial screening for both age groups (50 to 74 years, median of 3.4 to 5.1 vs. 4.1 to 6.5 deaths averted; 65 to 74 years, median of 1.5 to 2.1 vs. 1.8 to 2.6 deaths averted). Breast cancer deaths averted increased with annual versus biennial screening for women aged 50 to 74 years at all levels of breast density and an RR of 4.0, and those aged 65 to 74 years with heterogeneously or extremely dense breasts and an RR of 4.0. However, harms were almost 2-fold higher. Triennial screening for the average-risk subgroup and annual screening for the highest-risk subgroup cost less than $100 000 per QALY gained. Limitation:Models did not consider women younger than 50 years, those with an RR less than 1, or other imaging methods. Conclusion:Average-risk women with low breast density undergoing triennial screening and higher-risk women with high breast density receiving annual screening will maintain a similar or better balance of benefits and harms than average-risk women receiving biennial screening. Primary Funding Source:National Cancer Institute.

SUBMITTER: Trentham-Dietz A

PROVIDER: S-EPMC5125086 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Tailoring Breast Cancer Screening Intervals by Breast Density and Risk for Women Aged 50 Years or Older: Collaborative Modeling of Screening Outcomes.

Trentham-Dietz Amy A Kerlikowske Karla K Stout Natasha K NK Miglioretti Diana L DL Schechter Clyde B CB Ergun Mehmet Ali MA van den Broek Jeroen J JJ Alagoz Oguzhan O Sprague Brian L BL van Ravesteyn Nicolien T NT Near Aimee M AM Gangnon Ronald E RE Hampton John M JM Chandler Young Y de Koning Harry J HJ Mandelblatt Jeanne S JS Tosteson Anna N A AN

Annals of internal medicine 20160823 10

<h4>Background</h4>Biennial screening is generally recommended for average-risk women aged 50 to 74 years, but tailored screening may provide greater benefits.<h4>Objective</h4>To estimate outcomes for various screening intervals after age 50 years based on breast density and risk for breast cancer.<h4>Design</h4>Collaborative simulation modeling using national incidence, breast density, and screening performance data.<h4>Setting</h4>United States.<h4>Patients</h4>Women aged 50 years or older wi ...[more]

PMID: 27548583

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Project description:BackgroundColorectal cancer (CRC) screening is effective for early detection of CRC, particularly for males aged 50 or above. However, the rate of participation in the screening program is still low. This study was to examine knowledge, attitudes, and practice toward CRC and its screening and explored their associated factors.MethodsA descriptive cross-sectional study was conducted in a convenience sample of adults aged 50-75 years without cognitive problems, who were recruited at multi-elderly centers in Hong Kong. A questionnaire was used to measure knowledge, attitudes, and practice (KAP) towards CRC and its screening.ResultsThe total of 300 Chinese people included 147 (49.0%) males with a mean age of 58.72 (SD 6.91) years old. This study population had good knowledge and practice, as well as very good attitudes toward CRC and its screening. The multivariate regression results showed that receiving insurance coverage was the most significant factor positively associated with knowledge, attitudes, and practice. Other than this, lower educational level had significant negative association with knowledge and practice. Having self-sufficient financial support and receiving screening program information had positive associations with knowledge.ConclusionPeople who are receiving insurance coverage have better KAP towards CRC and its screening. This indicates that they can receive adequate information about the screening procedure from their insurance agents and receive financial support under their insurance coverage. Therefore, they are more willing to participate in the screening program. Other factors, including having good self-sufficient financial support and receiving adequate information about CRC and its screening, significantly enhance knowledge. Based on the relationships among KAP, knowledge enhancement can improve attitude and practice in participating in the CRC screening program. Those who attained lower education should receive more attention. In this sense, adequate financial support from health insurance or subsidies from the government can increase an individual's willingness to participate in the CRC screening, particularly those at a low socioeconomic level. Educational programs should be promoted to enhance knowledge about CRC and its screening, especially to those who attained lower education levels.

Project description:BACKGROUND:Controversy persists about optimal mammography screening strategies. OBJECTIVE:To evaluate screening outcomes, taking into account advances in mammography and treatment of breast cancer. DESIGN:Collaboration of 6 simulation models using national data on incidence, digital mammography performance, treatment effects, and other-cause mortality. SETTING:United States. PATIENTS:Average-risk U.S. female population and subgroups with varying risk, breast density, or comorbidity. INTERVENTION: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. MEASUREMENTS: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. LIMITATION:Other imaging technologies, polygenic risk, and nonadherence were not considered. CONCLUSION: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. PRIMARY FUNDING SOURCE:National Institutes of Health.

Project description:Importance:Fracture risk scores are used to identify individuals at high risk of major osteoporotic fracture or hip fracture for antiosteoporosis treatment. For those not meeting treatment thresholds at baseline, the optimal interval for reassessing fracture risk is uncertain. Objective:To examine reassessment intervals for transition from low to high fracture risk under guidelines-defined treatment thresholds. Design, Setting, and Participants:This retrospective cohort study included persons aged 50 years or older with fracture risk below treatment thresholds at baseline who had fracture risk reassessed at least 1 year later. Data were obtained from a population-based bone mineral density registry (baseline assessment during 1996-2015; reassessment to 2016) in the Province of Manitoba, Canada. Primary analysis was performed from May to June 2019. Analysis for the revision was performed in October 2019. Main Outcomes and Measures:The primary outcome was time to transition from low (below the treatment threshold) to high fracture risk (treatment-qualifying risk score using osteoporosis clinical practice guidelines strategies for Canada, the United States, and the United Kingdom). Results:The study population consisted of 10 564 individuals (94.1% women; mean [SD] age at baseline, 63.2 [8.2] years). At the time of reassessment (a mean [SD] interval of 5.2 [2.9] years between initial and subsequent fracture risk assessment), 690 (6.6%) had reached the fixed major osteoporotic fracture treatment threshold of 20%, 1546 (16.2%) had reached the fixed hip treatment threshold of 3%, and 932 (9.4%) had reached the age-dependent major osteoporotic fracture treatment threshold. Among those below 25% of the treatment threshold at baseline for each guideline, few (0%-3.0%) reached guidelines-defined high fracture risk at follow-up. In contrast, among those at the upper end of the scale for each guideline (75%-99% of the treatment threshold at baseline), 30.6% to 74.4% reached guidelines-defined high fracture risk. An increased number of clinical risk factors was associated with increased likelihood of reaching guidelines-defined high fracture risk (range for 3 guidelines, 17.1%-28.2%) compared with unchanged or decreased clinical risk factors (range for 3 guidelines, 3.3%-12.8%) (P < .001). Estimated time for 10% of the population to reach treatment-qualifying high fracture risk ranged from fewer than 3 years to more than 15 years. Conclusions and Relevance:The findings suggest that baseline fracture risk (as a fraction of the treatment threshold) and change in clinical risk factors can identify individuals with low and high probability of guidelines-defined high fracture risk during follow-up, thereby potentially helping to inform the reassessment interval.

Dataset Information

Tailoring Breast Cancer Screening Intervals by Breast Density and Risk for Women Aged 50 Years or Older: Collaborative Modeling of Screening Outcomes.

Publications

Tailoring Breast Cancer Screening Intervals by Breast Density and Risk for Women Aged 50 Years or Older: Collaborative Modeling of Screening Outcomes.

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