Quality‐of‐life effects of screening mammography in Norway

Abstract

Mammography screening may save women from dying of breast cancer, although it has not been shown to reduce all‐cause mortality. Screening also leads to overdiagnosis and many false positive mammograms aggravating women's quality‐of‐life. Quality adjusted life years (QALY) analyses of mammography screening have so far, calculated life years gained assuming that all prevented breast cancer deaths translate into a reduction in all‐cause mortality. We calculated net QALYs in two hypothesized cohorts of 100,000 Norwegian women; one screened biennially from age 50 to 69 years and one not screened. We followed both cohorts to age 85 years. We used EQ‐5D and an alternative equity weighted QALY instrument to estimate utility losses. In the screening cohort, we assumed 20% false positive tests during screening, different levels of overdiagnosis (20–75%) and different levels of breast cancer mortality reduction (10–30%). We assumed that reductions in breast cancer mortality only to a limited extent (20, 50 or 80%), resulted in reductions in all‐cause mortality. We calculated both undiscounted and discounted (4%) QALYs. Assuming that 50% of the reduction in breast cancer mortality translated to a reduction in all‐cause mortality and using estimated levels of benefits and harms in modern screening programs (50–75% overdiagnosis and 10% reduction in breast cancer mortality), undiscounted equity weighted QALY loss varied from 437 to 875 per 100,000 women. Using the levels of benefit and harms as reported in 30–40 years old randomized trials (30% overdiagnosis and 15% reduction in breast cancer mortality), undiscounted equity weighted QALY gain was 535 per 100,000. Net QALY in modern mammography screening in Norway is negative. Results could also be representative for Sweden, Denmark, UK and the US.

Quality of life among women with symptomatic, screen-detected, and interval breast cancer, and for women without breast cancer: a retrospective cross-sectional study from Norway

“…The studies comparing quality of life of breast cancer survivors of screening age and women without breast cancer showed inconsistent results [ 24 – 26 ]. QALYs for women with breast cancer associated with screening have never been compared based on data reported by the women, but rather from opinions of health care professionals or epidemiologists [ 27 , 28 ]. An ideal study design would include a prospective study comparing quality of life and QALYs among women in the four groups over decades.…”

The role of philosophy and ethics at the edges of medicine

“…Thereby we come to label and treat a great number of people as diseased appropriately. In our eager of doing something good we may end up doing too much, and in sum, doing more harm than good [39,41].…”

Får kvinner nok informasjon til å ta informerte valg ved mammografiscreening?

“…Men er informasjonen som gis god nok? Dette spørsmålet er saerlig aktuelt etter at screeningprogrammer har blitt kritisert for å overselge nytte (6,7) og for å ikke gi balansert informasjon tilpasset målgruppen (2)(3)(4)(5)(8)(9)(10). Saerlig har informasjon om risiko for falskt positive testresultater, overdiagnostikk og overbehandling vaert underkommunisert.…”