Barratt Alexandra L, Les Irwig M, Glasziou Paul P, Salkeld Glenn P, Houssami Nehmat
Department of Public Health and Community Medicine, University of Sydney, NSW.
Med J Aust. 2002 Mar 18;176(6):266-71. doi: 10.5694/j.1326-5377.2002.tb04405.x.
To assess the (i) benefits, (ii) harms and (iii) costs of continuing mammographic screening for women 70 years and over.
(i) We conducted a MEDLINE search (1966 - July 2000) for decision-analytic models estimating life-expectancy gains from screening in older women. The five studies meeting the inclusion criteria were critically appraised using standard criteria. We estimated relative benefit from each model's estimate of effectiveness of screening in older women relative to that in women aged 50-69 years using the same model. (ii) With data from BreastScreen Queensland, we constructed balance sheets of the consequences of screening for women in 10-year age groups (40-49 to 80-89 years), and (iii) we used a validated model to estimate the marginal cost-effectiveness of extending screening to women 70 years and over.
For women aged 70-79 years, the relative benefit was estimated as 40%-72%, and 18%-62% with adjustment for the impact of screening on quality of life. For women over 80 years the relative benefit was about a third, and with quality-of-life adjustment only 14%, that in women aged 50-69 years. (ii) Of 10,000 Australian women participating in ongoing screening, about 400 are recalled for further testing, and, depending on age, about 70-112 undergo biopsy and about 19-80 cancers are detected. (iii) Cost-effectiveness estimates for extending the upper age limit for mammographic screening from 69 to 79 years range from $8119 to $27 751 per quality-adjusted life-year saved, which compares favourably with extending screening to women aged 40-49 years (estimated at between $24,000 and $65,000 per life-year saved).
Women 70 years and over, in consultation with their healthcare providers, may want to decide for themselves whether to continue mammographic screening. Decision-support materials are needed for women in this age group.
评估对70岁及以上女性继续进行乳房X线筛查的（i）益处、（ii）危害和（iii）成本。
（i）我们在MEDLINE数据库（1966年 - 2000年7月）中进行检索，查找用于估计老年女性筛查预期寿命增益的决策分析模型。使用标准标准对符合纳入标准的五项研究进行严格评估。我们使用同一模型，根据每个模型对老年女性筛查有效性的估计，相对于50 - 69岁女性的筛查有效性，来估计相对益处。（ii）利用昆士兰乳房筛查的数据，我们编制了10岁年龄组（40 - 49岁至80 - 89岁）女性筛查后果的资产负债表，并且（iii）我们使用一个经过验证的模型来估计将筛查扩展至70岁及以上女性的边际成本效益。
对于70 - 79岁的女性，估计相对益处为40% - 72%，在对筛查对生活质量的影响进行调整后为18% - 62%。对于80岁以上的女性，相对益处约为三分之一，仅在对生活质量进行调整后为50 - 69岁女性的14%。（ii）在10000名参与正在进行的筛查的澳大利亚女性中，约400人被召回进一步检查，并且根据年龄不同，约70 - 112人接受活检，约19 - 80人被检测出患有癌症。（iii）将乳房X线筛查年龄上限从69岁扩展至79岁的成本效益估计为每挽救一个质量调整生命年8119美元至27751美元，这与将筛查扩展至40 - 49岁女性（估计为每挽救一个生命年24000美元至65000美元）相比更具优势。
70岁及以上的女性在与其医疗保健提供者协商后，可能希望自行决定是否继续进行乳房X线筛查。这个年龄组的女性需要决策支持材料。
