Benefits and Harms of Mammography Screening for Women With Down Syndrome: a Collaborative Modeling Study

Alagöz, Oğuzhan; Hajjar, Ali; Chootipongchaivat, Sarocha; Ravesteyn, Nicolien T. van; Yeh, Jennifer M.; Ergün, Meltem; Koning, Harry J. de; Chicoine, Brian; Martin, Barry

doi:10.1007/s11606-019-05182-5

Cited by 9 publications

(7 citation statements)

References 30 publications

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“…Another study by Alagoz et al evaluated the risk–benefit ratio of different mammography screening strategies in 1000 women with DS in the USA. The authors concluded that the benefit–harm ratio in terms of life years gained and harm from false-positive findings in a population with limited life expectancy and low cancer risk makes current breast cancer screening guidelines inappropriate for this specific population [ 22 ]. Based on these findings, other studies have also suggested that individuals with DS should be excluded from mass screening programs, and instead have annual clinical follow-ups and ultrasound or MRI in suspected cases [ 6 , 19 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Cancer Risk in Patients with Down Syndrome—A Retrospective Cohort Study from Germany

Krieg,

Loosen

et al. 2024

Cancers

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Background: Individuals with Down syndrome are thought to have a unique tumor profile. Methods: Using the IQVIA Disease Analyzer database, patients aged ≥18 years diagnosed with Down syndrome in German general practices between 2005 and 2021 were compared with patients without Down syndrome for cancer incidence, adjusting for age, sex, average annual visit frequency, and comorbidity. The 5-year cumulative incidence of cancer overall and specific cancers was analyzed using Kaplan–Meier curves and compared using the log-rank test. In addition, univariable Cox regression analysis was performed. Results: A total of 2438 patients with Down syndrome and 12,190 patients without Down syndrome were included; 3.9% of patients with Down syndrome and 3.1% of patients without Down syndrome were diagnosed with cancer (p = 0.143). Regression analysis showed no significant association between Down syndrome and subsequent cancer in the total population (HR: 0.79; 95% CI: 0.57–1.09), in women (HR: 0.89; 95% CI: 0.56–1.37), or in men (HR: 0.69; 95% CI: 0.43–1.11). Analyses by cancer type and sex showed a strong but not significant negative association between Down syndrome and breast cancer in women (HR: 0.33; 95% CI: 0.12–0.93). Conclusions: Our results could form the basis for future studies to clarify whether and to what extent an adapted screening program needs to be modified for individuals with Down syndrome due to the particular cancer distribution pattern.

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Section: Discussionmentioning

confidence: 99%

Cancer Risk in Patients with Down Syndrome—A Retrospective Cohort Study from Germany

Krieg,

Loosen

et al. 2024

Cancers

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“…In another example of person and health system level interactions, we used two of the CISNET models (Models E and WH) to evaluate the benefits and harms of mammography screening for women with Down syndrome, who have unique personal characteristics related to breast cancer outcomes [ 13 ]. Women with Down syndrome have lower breast cancer risk (approximately 75% lower risk of breast cancer compared to average-risk women) and significantly lower life expectancy (median 57.5 years in the US) than women without Down syndrome.…”

Section: Examples Of Cisnet Multilevel Modelingmentioning

confidence: 99%

“…CISNET breast cancer models incorporate data on distributions of tumor characteristics, women's risk factors, and healthcare use of breast cancer control interventions [5,6]. These models have been used to evaluate the impact of various screening and treatment interventions on multiple health outcomes in the overall United States population and population subgroups that differ by race, risk, and/or breast density [7][8][9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Reflecting on 20 years of breast cancer modeling in CISNET: Recommendations for future cancer systems modeling efforts

et al. 2021

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Since 2000, the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET) modeling teams have developed and applied microsimulation and statistical models of breast cancer. Here, we illustrate the use of collaborative breast cancer multilevel systems modeling in CISNET to demonstrate the flexibility of systems modeling to address important clinical and policy-relevant questions. Challenges and opportunities of future systems modeling are also summarized. The 6 CISNET breast cancer models embody the key features of systems modeling by incorporating numerous data sources and reflecting tumor, person, and health system factors that change over time and interact to affect the burden of breast cancer. Multidisciplinary modeling teams have explored alternative representations of breast cancer to reveal insights into breast cancer natural history, including the role of overdiagnosis and race differences in tumor characteristics. The models have been used to compare strategies for improving the balance of benefits and harms of breast cancer screening based on personal risk factors, including age, breast density, polygenic risk, and history of Down syndrome or a history of childhood cancer. The models have also provided evidence to support the delivery of care by simulating outcomes following clinical decisions about breast cancer treatment and estimating the relative impact of screening and treatment on the United States population. The insights provided by the CISNET breast cancer multilevel modeling efforts have informed policy and clinical guidelines. The 20 years of CISNET modeling experience has highlighted opportunities and challenges to expanding the impact of systems modeling. Moving forward, CISNET research will continue to use systems modeling to address cancer control issues, including modeling structural inequities affecting racial disparities in the burden of breast cancer. Future work will also leverage the lessons from team science, expand resource sharing, and foster the careers of early stage modeling scientists to ensure the sustainability of these efforts.

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“…2 The risk of solid tumors is also much lower than in people without Down syndrome, 3 with rates of breast cancer conservatively estimated to be 25% of those without Down syndrome. 4 These facts make our current screening guidelines for breast cancer seem inappropriate and likely harmful for adults with Down syndrome. However, there are no modifications to USPSTF guidelines in screening for adults with Down syndrome, as there are no large randomized controlled studies to inform practice.…”

mentioning

confidence: 99%

“…In lieu of a large randomized control trial, Alagoz et al 4 perform a computer simulation modeling of the efficacy of mammograms in adults with Down syndrome. They compare life years gained with the harm of false positives in a population with limited life expectancy and lower risk of cancer.…”

mentioning

confidence: 99%

Capsule Commentary on Alagoz et al., Benefits and Harms of Mammography Screening for Women with Down Syndrome

Bulova

2019

J GEN INTERN MED

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Benefits and Harms of Mammography Screening for Women With Down Syndrome: a Collaborative Modeling Study

Cited by 9 publications

References 30 publications

Cancer Risk in Patients with Down Syndrome—A Retrospective Cohort Study from Germany

Cancer Risk in Patients with Down Syndrome—A Retrospective Cohort Study from Germany

Reflecting on 20 years of breast cancer modeling in CISNET: Recommendations for future cancer systems modeling efforts

Capsule Commentary on Alagoz et al., Benefits and Harms of Mammography Screening for Women with Down Syndrome

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