![]() ![]() The majority of 43 identified studies focused on promoting mammography screening in women of different ages, with only four studies focusing on the overuse of mammography in women ≥ 70 years old. This narrative review synthesizes qualitative and quantitative evidence around older women’s perspectives toward mammography screening. National Cancer Institute and National Institutes of Health.Įxamining what older women know and perceive about mammography screening is critical for understanding patterns of under- and overuse, and concordance with screening mammography guidelines in the USA. Women considering screening beyond age 75 years should weigh the potential harms of overdiagnosis versus the potential benefit of averting death from breast cancer. No randomized controlled trials of screening mammography beyond age 75 years are available to provide model parameter inputs.Īlthough annual mammography is not cost-effective, biennial screening mammography to age 80 years is however, the absolute number of deaths averted is small, especially for women with comorbidities. Overdiagnosis cases were double the number of deaths averted from breast cancer.Ĭosts per QALY gained were sensitive to changes in invasive cancer incidence and shift of breast cancer stage with screening mammography. Annual mammography beyond age 75 years was not cost-effective, but extending biennial mammography to age 80 years was ($54 000, $65 000, and $85 000 per quality-adjusted life-year gained for women with CCSs of 0, 1, and ≥2, respectively). Screening mammography to age 75, 80, 85, or 90 years.īreast cancer death, survival, and costs.Įxtending biennial mammography from age 75 to 80 years averted 1.7, 1.4, and 1.0 breast cancer deaths and increased days of life gained by 5.8, 4.2, and 2.7 days per 1000 women for comorbidity scores of 0, 1, and 2, respectively. women aged 65 to 90 years in groups defined by Charlson comorbidity score (CCS). SEER (Surveillance, Epidemiology, and End Results) program and Breast Cancer Surveillance Consortium. To estimate benefits, harms, and cost-effectiveness of extending mammography to age 80, 85, or 90 years according to comorbidity burden. The cost-effectiveness of screening mammography beyond age 75 years remains unclear. Decisions about the best strategy depend on program and individual objectives and the weight placed on benefits, harms, and resource considerations. Results do not include morbidity from false-positive results, patient knowledge of earlier diagnosis, or unnecessary treatment.īiennial screening achieves most of the benefit of annual screening with less harm. Varying test sensitivity or treatment patterns did not change conclusions. Biennial screening after age 69 years yielded some additional mortality reduction in all models, but overdiagnosis increased most substantially at older ages. ![]() 50 years) reduced mortality by an additional 3% (range, 1% to 6%), consumed more resources, and yielded more false-positive results. ![]() Initiating biennial screening at age 40 years (vs. Screening biennially from ages 50 to 69 years achieved a median 16.5% (range, 15% to 23%) reduction in breast cancer deaths versus no screening. Screening biennially maintained an average of 81% (range across strategies and models, 67% to 99%) of the benefit of annual screening with almost half the number of false-positive results. The 6 models produced consistent rankings of screening strategies. no screening), false-positive results, unnecessary biopsies, and overdiagnosis. Number of mammograms, reduction in deaths from breast cancer or life-years gained (vs. National data on age-specific incidence, competing mortality, mammography characteristics, and treatment effects.Ģ0 screening strategies with varying initiation and cessation ages applied annually or biennially. Despite trials of mammography and widespread use, optimal screening policy is controversial. ![]()
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