Comparison of recommendations for screening mammography using CISNET models

Abstract

CISNET models demonstrate that the greatest mortality reduction is achieved with annual screening of women starting at age 40 years. Cancer 2017;123:3673-3680. © 2017 American Cancer Society.

Opportunity cost of annual screening mammography

“…The ACR recommendation for annual screening starting at age 40 years and ending at age 84 years was found to have a greater benefit in breast cancer mortality reduction in both analyses compared with that of the USPSTF (biennial, ages 50‐74 years) (38/26 vs 40/23), as would be expected. Arleo et al did not provide the incremental benefit of annual screening beyond age 74 years in terms of relative or absolute risk reduction. The previous CISNET modeling of overdiagnosis in this older age group did not use annual screening and did not account for resource costs.…”

“…Arleo et al used Cancer Intervention and Surveillance Modeling Network (CISNET) computer modeling to compare the benefit and harms from 3 different screening recommendations from the American College of Radiology (ACR), the American Cancer Society (ACS), and the US Preventive Services Task Force (USPSTF) . Mandelblatt et al modeled multiple screening strategies ending at age 74 years and by comparing life‐years gained with mammograms performed found that both the ACR and USPSTF strategies were efficient, whereas hybrid strategies such as that of the ACS were not .…”

Reply to Opportunity cost of annual screening mammography

“…We thank Dr. Keen for responding to our article . Much of his response is regarding cost, which is beyond the scope of our article and to our knowledge is not discussed in any of the national organization screening guidelines.…”

“…Keen's letter is overdiagnosis. We explicitly stated in the “Methods” section why our article did not discuss overdiagnosis: “Because both CISNET [Cancer Intervention and Surveillance Modeling Network] modelers and the USPSTF [US Preventive Services Task Force] acknowledge that ‘methods for estimating overdiagnosis at a population level are not well established’ and ‘Existing science does not allow for the ability to determine precisely what proportion of cancer diagnosed by mammography today reflects overdiagnosis, and estimates vary widely depending on the data source and method of calculation used,’ the decision was made not to include overdiagnosis in this study's risk assessment.” However, because Dr. Keen raises the issue, we would like to stress that overdiagnosis is not reduced by screening less frequently or by initiating screening at a later age.…”

“…Women considering screening mammography should be aware that the greatest reduction in breast cancer‐specific mortality is achieved with annual screening mammography starting at age 40 years, with CISNET computer models demonstrating a nearly 40% reduction in breast cancer‐specific mortality compared with only a 23% reduction associated with biennial screening of women aged 50 to 74 years . Screening mammography decisions should be made by women, not for women.…”