de Koning H J, van Ineveld B M, van Oortmarssen G J, de Haes J C, Collette H J, Hendriks J H, van der Maas P J
Dept. of Public Health and Social Medicine, Erasmus University, Rotterdam, The Netherlands.
Int J Cancer. 1991 Oct 21;49(4):531-7. doi: 10.1002/ijc.2910490410.
Mammographic screening for women aged 50-70 is effective in reducing breast cancer mortality, but the impact on quality of life and the attainable mortality reduction remain to be discussed. The consequences of expanding screening programmes to include women in other age groups are uncertain. We have predicted the effects and costs for 5 popular screening variants, differing in age group and screening interval, on the basis of our analysis of the Dutch screening trials and of the reported mortality reductions in other trials. We have also investigated the influence of a large number of uncertain factors. Screening for women aged 50 and over with a 2- or 3-year interval is very cost-effective and will result in reductions of respectively 16% or 10% in breast cancer mortality in a real population. Variation of most variables keeps the cost-effectiveness (CE) ratio limited to the range of US $3,000 to 5,000 per life-year gained. A 2- to 3-fold change in CE ratio would only occur if the extreme estimates of mortality reduction in the Swedish screening trials were applied. The impact on quality of life (QoL) is limited: for the 2-yearly screening policy for women aged 50-70, the cost per Quality-Adjusted Life-Year (QALY) gained is 4,050, whereas the cost per life-year gained is US $3,825. The CE ratio for 2-yearly screening of women aged 40-70 is 5,400, but the additional cost per additional life-year gained is US $35,000. It would be preferable by far to extend the screening programme to women over the age of 70 or to shorten the screening interval for women aged 50-70. Screening performances, the demand for mammograms outside screening and the possibility of a survival improvement irrespective of screening have a strong impact on QoL and CE.
对50至70岁女性进行乳腺钼靶筛查在降低乳腺癌死亡率方面是有效的，但对生活质量的影响以及可实现的死亡率降低仍有待探讨。将筛查计划扩大到其他年龄组女性的后果尚不确定。基于我们对荷兰筛查试验的分析以及其他试验中报告的死亡率降低情况，我们预测了5种不同年龄组和筛查间隔的常见筛查方案的效果和成本。我们还研究了大量不确定因素的影响。对50岁及以上女性每2年或3年进行一次筛查具有很高的成本效益，在实际人群中可分别降低16%或10%的乳腺癌死亡率。大多数变量的变化使成本效益（CE）比限制在每获得一个生命年3000至5000美元的范围内。只有应用瑞典筛查试验中死亡率降低的极端估计值，CE比才会出现2至3倍的变化。对生活质量（QoL）的影响有限：对于50至70岁女性的两年一次筛查政策，每获得一个质量调整生命年（QALY）的成本为4050美元，而每获得一个生命年的成本为3825美元。对40至70岁女性进行两年一次筛查的CE比为5400，但每多获得一个生命年的额外成本为35000美元。将筛查计划扩大到70岁以上女性或缩短50至70岁女性的筛查间隔要远为可取。筛查性能、筛查外的乳房X光检查需求以及无论筛查与否生存改善的可能性对生活质量和成本效益有很大影响。
