The impact of mammographic screening on breast cancer mortality: overview of the evidence so far

10561 Background: Screening mammography has shown to decrease breast cancer specific death rate by 20–25% and has been recommended in women aged 40 and above, nevertheless, some country service screen programs stop screening in women older than 69, even though the sensitivity and specificity of screening mammography is highest in older women, especially those older than 80 years. The size of the older population is growing exponentially and old women have the highest incidence of breast cancer; one third of breast cancer diagnosis and half the deaths of breast cancer in USA occurred in women aged 70 and above in the year 2000. The aim of this study is to estimate the impact of mammographic screening in women aged 70 and above on breast cancer mortality. Methods: US Census, SEER, CISNET, CDC, HMD, ULTD databases were searched to obtain population data and rates of incidence and mortality of breast cancer by age. In addition, mammography screening bibliography from randomized clinical trials, meta-analysis, and service health programs publications were reviewed to estimate the impact of screening mammography on results for different strata. Analytical and simulation methods were applied for modeling the data with the aid of Mathematica to calculate breast cancer reduction rate. Results: A reduction in breast cancer mortality was observed with a magnitude proportional to age, even after taking into account competing risks of death by other causes in the aging population. Simulation of different scenarios revealed a decrease in breast cancer mortality in the range of 5 to15% for women younger than 50 years, 15 to 25% in the group of women aged 50 to 69, and 25 to 35% in women older than 69. Factors such as population life expectancy, breast cancer incidence, attrition rate in screening or cross-over, overall specificity of mammographic detection, interval of screening, impact the estimations, explaining in part some of the negative results of prevention trials. Conclusions: Reduction of breast cancer mortality by mammographic screening is proportional to age. Women aged 70 and above benefit more from mammographic screening than younger women. No significant financial relationships to disclose.

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The Impact of Mammographic Screening on Breast Cancer Mortality in Europe: A Review of Trend Studies

Journal of Medical Screening ◽

10.1258/jms.2012.012079 ◽

2012 ◽

Vol 19 (1_suppl) ◽

pp. 26-32 ◽

Cited By ~ 56

Author(s):

Sm Moss ◽

L Nyström ◽

H Jonsson ◽

E Paci ◽

E Lynge ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Mortality ◽

Breast Cancer Mortality ◽

Mammographic Screening ◽

The Impact

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The relative effect of mammographic screening on breast cancer mortality by socioeconomic status

Medicine ◽

10.1097/md.0000000000004335 ◽

2016 ◽

Vol 95 (31) ◽

pp. e4335 ◽

Cited By ~ 3

Author(s):

Theodora M. Ripping ◽

Danielle van der Waal ◽

André L.M. Verbeek ◽

Mireille J.M. Broeders

Keyword(s):

Breast Cancer ◽

Socioeconomic Status ◽

Cancer Mortality ◽

Breast Cancer Mortality ◽

Mammographic Screening ◽

Relative Effect

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Assessment of Breast Cancer Mortality Trends Associated With Mammographic Screening and Adjuvant Therapy From 1986 to 2013 in the State of Victoria, Australia

JAMA Network Open ◽

10.1001/jamanetworkopen.2020.8249 ◽

2020 ◽

Vol 3 (6) ◽

pp. e208249 ◽

Cited By ~ 1

Author(s):

Robert Burton ◽

Christopher Stevenson

Keyword(s):

Breast Cancer ◽

Adjuvant Therapy ◽

Cancer Mortality ◽

Breast Cancer Mortality ◽

Mammographic Screening ◽

The State ◽

Mortality Trends

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82 Effect of a quarter century of adjuvant therapy and mammographic screening on breast cancer mortality in the state of victoria, australia

10.1136/bmjebm-2019-pod.94 ◽

2019 ◽

Author(s):

Robert Burton ◽

Christopher Stephenson

Keyword(s):

Breast Cancer ◽

Adjuvant Therapy ◽

Cancer Mortality ◽

Breast Cancer Mortality ◽

Mammographic Screening ◽

The State ◽

Quarter Century

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A trial to study the effect on breast cancer mortality of annual mammographic screening in women starting at age 40

Journal of Medical Screening ◽

10.1136/jms.6.3.144 ◽

1999 ◽

Vol 6 (3) ◽

pp. 144-148 ◽

Cited By ~ 39

Author(s):

S. Moss

Keyword(s):

Breast Cancer ◽

Cancer Mortality ◽

Breast Cancer Mortality ◽

Mammographic Screening

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Examining the impact of frequent versus infrequent screenings for breast cancer on employer costs.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e16550 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e16550-e16550

Author(s):

Kavita V. Nair ◽

Vahram Ghushchyan ◽

Lisa A Thompson ◽

Cindy L. O'Bryant ◽

Richard Read Allen ◽

...

Keyword(s):

Breast Cancer ◽

Chronic Condition ◽

Linear Models ◽

Breast Cancer Mortality ◽

Condition Index ◽

Baseline Period ◽

Mammographic Screening ◽

Index Number ◽

The Impact

e16550 Background: Studies have shown an effective way to reduce breast cancer mortality is through early detection with periodic mammographic screening. Screening can increase the likelihood that cancer is detected at an earlier stage when treatment can be more effective and less expensively. Employers may be motivated to improve screening efforts if it results in improved survival and lower healthcare costs. We estimated differences in breast cancer and all cause related costs for women between 40-65 years who received regular screenings compared to those who did not. Methods: Data obtained from the LifeLink™ Health Plan Claims Database (2000 – 2010). ICD-9 codes (174.xx and 233.xx) were used to identify women between 40-65 with a diagnosis for breast cancer, who had an mammogram in the 6 months prior to diagnosis (baseline period) and had a minimum of 12 months following the diagnosis. Two cohorts were created. Those with at least one additional mammogram in the 12 months prior to the start of the baseline period (frequent mammogram group) and those with no additional mammograms (infrequent group). Both groups were followed for a minimum of 12 months and a maximum of 10 years. Adjusted differences in breast cancer and all cause costs were examined controlling for age, chronic condition index, number of mammograms in the baseline period, region and years of follow up using generalized linear models. Results: Mean age was 54 in the frequent (n=1582) and 56 in the infrequent (n=1379) group. Infrequent group had 29.7% of women between 40-49 years compared to 23.6% in the frequent group. Majority of the frequent group (85%) had one additional mammogram in the 12 months preceding the baseline period while 15% had > 2 mammograms. Infrequent group incurred on average $5715 higher breast cancer costs in year one compared to the frequent group (p <0.001). All cause costs in year one were also $6222 higher in the infrequent group (p<0.001). Similar trends were seen in years 2-5 for breast cancer and years 2-3 for all cause costs. Differences were consistent for each year of age from 40-65. Conclusions: Our findings suggest that efforts to improve screening rates can affect employer costs for treating breast cancer between 1-5 years following diagnosis.

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