Toward optimal screening strategies for older women

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• 作者：Dr. Jeanne S. Mandelblatt MD ; MPH (1)
  Clyde B. Schechter MD (3)
  K. Robin Yabroff MBA ; PhD (1)
  Dr. William Lawrence MD ; Msc (1)
  James Dignam PhD (5)
  Martine Extermann MD (6)
  Sarah Fox PhD (7)
  Gretchen Orosz MD (8)
  Rebecca Silliman MD ; MPH ; PhD (9)
  Jennifer Cullen PhD ; MPH (1)
  Lodovico Balducci MD (6)
  
• 关键词：screening ; cost ; effectiveness ; breast neoplasms ; elderly
• 刊名：Journal of General Internal Medicine
• 出版年：2005
• 出版时间：June 2005
• 年：2005
• 卷：20
• 期：6
• 页码：487-496
• 全文大小：146KB
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• 作者单位：Dr. Jeanne S. Mandelblatt MD, MPH (1)
  Clyde B. Schechter MD (3)
  K. Robin Yabroff MBA, PhD (1)
  Dr. William Lawrence MD, Msc (1)
  James Dignam PhD (5)
  Martine Extermann MD (6)
  Sarah Fox PhD (7)
  Gretchen Orosz MD (8)
  Rebecca Silliman MD, MPH, PhD (9)
  Jennifer Cullen PhD, MPH (1)
  Lodovico Balducci MD (6)
  
  1. Department of Oncology, Georgetown University Medical Center, and Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
  3. Department of Family Medicine, Albert Einstein School of Medicine, Bronx, NY, USA
  5. Department of Health Studies and University of Chicago Cancer Research Center, University of Chicago, Chicago, IL, USA
  6. Department of Medicine, H. Lee Moffit Cancer Center, Tampa, FL, USA
  7. Department of Medicine, UCLA, Los Angeles, CA, USA
  8. Department of Geriatrics, Mount Sinai School of Medicine, New York, NY, USA
  9. Departments of Medicine and Epidemiology and Biostatistics, Boston University Schools of Medicine and Public Health, Boston, MA, USA
  

文摘

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 ? 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.