This is a summary of a study published as a preprint on SSRN.com. It has not yet been peer reviewed.
Key Takeaways
Mammography screening decreases mortality in breast cancer in patients aged 40-80 years.
As mortality increase with age, screening at age 70 years is more beneficial than screening at age 48 years.
The study recommends ten mammography screenings be performed biennially beginning at age 50 years.
Why This Matters
If a mammography screening program were to be expanded, the benefit must be demonstrated for each additional age.
Screening with mammograms has been shown to increase 20-year survival rate from 68% (nonscreened patients) to 83% (screened patients).
Study Design
This was a modeling study using data from the Munich Cancer Registry for the year 2018, during which 2.92 million mammography screenings were performed.
The patients screened were aged 40-80 years.
Out of those screened, 13,414 patients were diagnosed with invasive breast cancer.
The modelling approach used the Gompertz function to extrapolate 15-year and 20-year survival rate in patients who have been screened vs those who haven’t.
The study generated tumor-dependent and tumor-independent deaths in 20 years of follow-up using 21 cohorts of screened vs nonscreened patients between ages 40 and 80 years at 2-year intervals.
Each study was repeated 50 times to reduce randomness in variables generated.
Year of death was estimated using hazard rates.
Key Results
For the mean tumor size, survival rate at 15 years was 87.8% in the screened group compared with 76% in the nonscreened group.
At 20 years, the survival rate in the screened group was 83.2% compared with 68% in the nonscreened group.
Mortality reduction for screening intervals between 50 and 69 years was 54.5% (the current estimate is 49%).
Mortality increases with age; hence, more deaths are prevented when screening is done at age 70 years compared with age 48 years.
When 12 screenings are performed, screening between ages 50 and 73 years prevented more deaths compared with screening between ages 48 and 71 years.
Limitations
Modeling studies can only provide estimates and generate hypothesis. Clinical trials to confirm projections are required to provide evidence-based recommendations.
Only mortality effects were considered in the study. Patient-dependant factors relevant to the quality of life such as association between age-dependant breast density and false positives were not considered.
Disclosures
The authors declared no conflict of interest or funding.
This is a summary of a preprint research study, “ Modeling Mammography Screening With Age-Specific Screening Cohorts ,” led by Dieter Hoelzel, MD, PhD, and colleagues, from the Ludwig Maximilian University of Munich, Germany, and published on SSRN.com. It is provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on SSRN.com.
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