Collaborative Modeling to Compare Different Breast Cancer Screening Strategies
Authors: Trentham-Dietz Amy , Chapman Christina Hunter , Jayasekera Jinani , Lowry Kathryn P. , Heckman-Stoddard Brandy M. , Hampton John M. , Caswell-Jin Jennifer L. , Gangnon Ronald E. , Lu Ying , Huang Hui , Stein Sarah , Sun Liyang , Gil Quessep Eugenio J. , Yang Yuanliang , Lu Yifan , Song Juhee , Muñoz Diego F. , Li Yisheng , Kurian Allison W. , Kerlikowske Karla , O’Meara Ellen S. , Sprague Brian L. , Tosteson Anna N. A. , Feuer Eric J. , Berry Donald , Plevritis Sylvia K. , Huang Xuelin , de Koning Harry J. , van Ravesteyn Nicolien T. , Lee Sandra J. , Alagoz Oguzhan , Schechter Clyde B. , Stout Natasha K. , Miglioretti Diana L. , Mandelblatt Jeanne S. 
Published: April 2024

Importance

The effects of breast cancer incidence changes and advances in screening and treatment on outcomes of different screening strategies are not well known.

Objective

To estimate outcomes of various mammography screening strategies.

Design, Setting, and Population

Comparison of outcomes using 6 Cancer Intervention and Surveillance Modeling Network (CISNET) models and national data on breast cancer incidence, mammography performance, treatment effects, and other-cause mortality in US women without previous cancer diagnoses.

Exposures

Thirty-six screening strategies with varying start ages (40, 45, 50 years) and stop ages (74, 79 years) with digital mammography or digital breast tomosynthesis (DBT) annually, biennially, or a combination of intervals. Strategies were evaluated for all women and for Black women, assuming 100% screening adherence and “real-world” treatment.

Main Outcomes and Measures

Estimated lifetime benefits (breast cancer deaths averted, percent reduction in breast cancer mortality, life-years gained), harms (false-positive recalls, benign biopsies, overdiagnosis), and number of mammograms per 1000 women.

Results

Biennial screening with DBT starting at age 40, 45, or 50 years until age 74 years averted a median of 8.2, 7.5, or 6.7 breast cancer deaths per 1000 women screened, respectively, vs no screening. Biennial DBT screening at age 40 to 74 years (vs no screening) was associated with a 30.0% breast cancer mortality reduction, 1376 false-positive recalls, and 14 overdiagnosed cases per 1000 women screened. Digital mammography screening benefits were similar to those for DBT but had more false-positive recalls. Annual screening increased benefits but resulted in more false-positive recalls and overdiagnosed cases. Benefit-to-harm ratios of continuing screening until age 79 years were similar or superior to stopping at age 74. In all strategies, women with higher-than-average breast cancer risk, higher breast density, and lower comorbidity level experienced greater screening benefits than other groups. Annual screening of Black women from age 40 to 49 years with biennial screening thereafter reduced breast cancer mortality disparities while maintaining similar benefit-to-harm trade-offs as for all women.

Conclusions

This modeling analysis suggests that biennial mammography screening starting at age 40 years reduces breast cancer mortality and increases life-years gained per mammogram. More intensive screening for women with greater risk of breast cancer diagnosis or death can maintain similar benefit-to-harm trade-offs and reduce mortality disparities.