Caro JJ, O'Brien JA, Hartz SC; International Society of Technology Assessment in Health Care. Meeting.
Abstr Int Soc Technol Assess Health Care Meet. 1993; 9: 117.
Medical Research International, Boston.
While mammographic screening has been shown to prolong life in women older than 50 yrs, the epidemiologic evidence does not support this intervention in younger women. And yet, there is strong apriori reason to believe that early cancer detection improves survival--regardless of age. To address this controversy, the relevant factors were estimated from an extensive literature review and the resulting cost-effectiveness (CE) was derived. A model incorporating the impact of age-related differences in breast cancer incidence, diagnostic accuracy, tumour progression rates, survival, and participation was created and functions, incorporating all the factors, relating CE to mortality reduction (MR) were developed. With 40% false negatives in younger women and a median survival of 15 years, the CE remains below US $35,000 per life-year gained (LYG) (the typical level for dialysis) so long as at least 7% MR can be obtained with 75% participation and biennial screening. If 100% participation and annual screening are required to obtain a benefit, then at least a 16% MR must be achieved for CE to remain below $35,000 per LYG. Meta-analysis of the incidence density data from the 3 recent randomized trials that included younger women (Two-County, Malm?o, Canadian) results in a best estimate of only 3% mortality reduction. In light of the 15-year average survival in younger women with breast cancer, and the results of the Health Insurance Plan study, the shorter follow-up in all recent studies leaves open the possibility that greater mortality reductions may yet accrue. Even if a sufficient reduction in mortality were obtained after 15 years, the initial ineffective period would add considerable cost and 4,500 false positives per 100,000 women screened per year. Increased breast tissue density and possibly faster tumour progression rate in younger women may require higher sensitivity and shorter screening intervals. This has not been studied and the mortality reductions that might be achieved remain speculative. The results of this analysis incorporating the most recent findings of all studies on the subject suggest that the benefits of mammographic screening of women below the age of 50 are still too uncertain to issue well-founded guidelines.
Publication Types:
Keywords:
- Breast Neoplasms
- Canada
- Clinical Trials as Topic
- Cost-Benefit Analysis
- Female
- Humans
- Incidence
- Mass Screening
- Meta-Analysis
- Risk Assessment
- Risk Management
- diagnosis
- economics
- mortality
- hsrmtgs
Other ID:
UI: 102211501
From Meeting Abstracts