Impact of extending screening mammography to older women Information to support informed choices

Abstract

From 2013 through 2017, the Australian national breast cancer screening programme is gradually inviting women aged 70-74 years to attend screening, following a policy decision to extend invitations to older women. We estimate the benefits and harms of the new package of biennial screening from age 50-74 compared with the previous programme of screening from age 50-69. Using a Markov model, we applied estimates of the relative risk reduction for breast cancer mortality and the risk of overdiagnosis from the Independent UK Panel on Breast Cancer Screening review to Australian breast cancer incidence and mortality data. We estimated screening specific outcomes (recalls for further imaging, biopsies, false positives, and interval cancer rates) from data published by BreastScreen Australia. When compared with stopping at age 69, screening 1,000 women to age 74 is likely to avert one more breast cancer death, with an additional 78 women receiving a false positive result and another 28 women diagnosed with breast cancer, of whom eight will be overdiagnosed and overtreated. The extra 5 years of screening results in approximately 7 more overdiagnosed cancers to avert one more breast cancer death. Thus extending screening mammography in Australia to older women results in a less favourable harm to benefit ratio than stopping at age 69. Supporting informed decision making for this age group should be a public health priority.

Women’s Acceptance of Overdetection in Breast Cancer Screening: Can We Assess Harm-Benefit Tradeoffs?

“…Second, 5 cancers were overdetected, a conservative estimate alongside the 5 deaths avoided. Third, 30 cancers were overdetected (Australian estimate of overdetection 3 ). Fourth, 15 cancers were overdetected (Independent UK Panel estimate 2 ).…”

“…In Australia, the ratio was found to be 1:6. 3 In the Netherlands, a reversed ratio of 2:1 was reported, based on a comparison of regions where screening was introduced at different time points, as well as on modeling studies. 4 Given the evidence of overdiagnosis, an individual may rationally choose not to screen, and informed choice has become a major stated goal of information provision in screening programs.…”

A multicenter hospital-based diagnosis study of automated breast ultrasound system in detecting breast cancer among Chinese women

“…Then, all enrolled participants underwent successive HHUS and ABUS examinations. The women in the older age group also underwent MG; those in the younger age group did not undergo MG due to concerns of radiation (20,21) (Figure 1).…”

Effect of different communication strategies about stopping cancer screening on screening intention and cancer anxiety: a randomised online trial of older adults in Australia

“…[1][2][3] For example, the benefits of regular prostate-specific antigen (PSA) testing are uncertain for men in general, but especially for those aged over 70 years [4][5][6] and women aged over 74 years who routinely screen for breast cancer are also unlikely to benefit. [7][8][9] Continued routine cancer screening in older adults can also lead to harm, including…”