Journal of General Internal Medicine

, Volume 20, Issue 6, pp 487–496 | Cite as

Toward optimal screening strategies for older women

Costs, benefits, and harms of breast cancer screening by age, biology, and health status
  • Jeanne S. Mandelblatt
  • Clyde B. Schechter
  • K. Robin Yabroff
  • William Lawrence
  • James Dignam
  • Martine Extermann
  • Sarah Fox
  • Gretchen Orosz
  • Rebecca Silliman
  • Jennifer Cullen
  • Lodovico Balducci
  • the Breast Cancer in Older Women Research Consortium
Original Article

Abstract

CONTEXT: Optimal ages of breast cancer screening cessation remain uncertain.

OBJECTIVE: To evaluate screening policies based on age and quartiles of life expectancy (LE).

DESIGN AND POPULATION: We used a stochastic model with proxies of age-dependent biology to evaluate the incremental U.S. societal costs and benefits of biennial screening from age 50 until age 70, 79, or lifetime.

MAIN OUTCOME MEASURES: Discounted incremental costs per life years saved (LYS).

RESULTS: Lifetime screening is expensive ($151,434 per LYS) if women have treatment and survival comparable to clinical trials (idealized); stopping at age 79 costs $82,063 per LYS. This latter result corresponds to costs associated with an LE of 9.5 years at age 79, a value expected for 75% of 79-year-olds, about 50% of 80-year-olds, and 25% of 85-year-olds. Using actual treatment and survival patterns, screening benefits are greater, and lifetime screening of all women might be considered ($114, 905 per LYS), especially for women in the top 25% of LE for their age ($50,643 per LYS, life expectancy of ∼7 years at age 90).

CONCLUSIONS: If all women receive idealized treatment, the benefits of mammography beyond age 79 are too low relative to their costs to justify continued screening. However, if treatment is not ideal, extending screening beyond age 79 could be considered, especially for women in the top 25% of life expectancy for their age.

Key Words

screening cost-effectiveness breast neoplasms elderly 

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Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Jeanne S. Mandelblatt
    • 1
  • Clyde B. Schechter
    • 2
  • K. Robin Yabroff
    • 1
  • William Lawrence
    • 1
  • James Dignam
    • 3
  • Martine Extermann
    • 4
  • Sarah Fox
    • 5
  • Gretchen Orosz
    • 6
  • Rebecca Silliman
    • 7
  • Jennifer Cullen
    • 1
  • Lodovico Balducci
    • 4
  • the Breast Cancer in Older Women Research Consortium
  1. 1.Department of OncologyGeorgetown University Medical Center, and Cancer Control Program, Lombardi Comprehensive Cancer CenterWashington, DCUSA
  2. 2.Department of Family MedicineAlbert Einstein School of MedicineBronxUSA
  3. 3.Department of Health Studies and University of Chicago Cancer Research CenterUniversity of ChicagoChicagoUSA
  4. 4.Department of MedicineH. Lee Moffit Cancer CenterTampaUSA
  5. 5.Department of MedicineUCLALos AngelesUSA
  6. 6.Department of GeriatricsMount Sinai School of MedicineNew YorkUSA
  7. 7.Departments of Medicine and Epidemiology and BiostatisticsBoston University Schools of Medicine and Public HealthBostonUSA

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