Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands; School of Population Health Sciences, Faculty of Life Sciences and Medicine; and Biomedical Research Centre, King's College London, Guy's Campus, AH 3.2, SE1 1UL London, United Kingdom.
Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands; Department of Radiology, Free University Brussels, University Hospital Brussels, Laarbeeklaan 101, B-1090 Brussels, Belgium.
Maturitas. 2018 Mar;109:81-88. doi: 10.1016/j.maturitas.2017.12.009. Epub 2017 Dec 15.
Because the incidence of breast cancer increases between 45 and 50years of age, a reconsideration is required of the current starting age (typically 50years) for routine mammography. Our aim was to evaluate the quantitative benefits, harms, and cost-effectiveness of lowering the starting age of breast cancer screening in the Dutch general population.
Economic modelling with a lifelong perspective compared biennial screening for women aged 48-74years and for women aged 46-74years with the current Dutch screening programme, which screen women between the ages of 50 and 74years. Tumour deaths prevented, years of life saved (YOLS), false-positive rates, radiation-induced tumours, costs and incremental cost-effectiveness ratios (ICERs) were evaluated.
Starting the screening at 48 instead of 50 years of age led to increases in: the number of small tumours detected (4.0%), tumour deaths prevented (5.6%), false positives (9.2%), YOLS (5.6%), radiation-induced tumours (14.7%), and costs (4.1%). Starting the screening at 46 instead of 48 years of age increased the number of small tumours detected (3.3%), tumour deaths prevented (4.2%), false positives (8.8%), YOLS (3.7%), radiation-induced tumours (15.2%), and costs (4.0%). The ICER was €5600/YOLS for the 48-74 scenario and €5600/YOLS for the 46-74 scenario.
Women could benefit from lowering the starting age of screening as more breast cancer deaths would be averted. Starting regular breast cancer screening earlier is also cost-effective. As the number of additional expected harms is relatively small in both the scenarios examined, and the difference in ICERs is not large, introducing two additional screening rounds is justifiable.
由于乳腺癌的发病率在 45 至 50 岁之间增加，因此需要重新考虑当前的常规乳房 X 光筛查起始年龄（通常为 50 岁）。我们的目的是评估降低荷兰普通人群乳腺癌筛查起始年龄的定量效益、危害和成本效益。
从终生角度进行经济建模，比较对 48-74 岁女性进行每两年一次的筛查和对 46-74 岁女性进行筛查，与当前对 50-74 岁女性进行的荷兰筛查方案进行比较。评估预防肿瘤死亡、挽救生命年（YOLS）、假阳性率、辐射诱导肿瘤、成本和增量成本效益比（ICER）。
将筛查起始年龄从 50 岁提前至 48 岁会导致：小肿瘤检出数量增加（4.0%）、预防肿瘤死亡人数增加（5.6%）、假阳性率增加（9.2%）、YOLS 增加（5.6%）、辐射诱导肿瘤增加（14.7%）、成本增加（4.1%）。将筛查起始年龄从 48 岁提前至 46 岁会导致：小肿瘤检出数量增加（3.3%）、预防肿瘤死亡人数增加（4.2%）、假阳性率增加（8.8%）、YOLS 增加（3.7%）、辐射诱导肿瘤增加（15.2%）、成本增加（4.0%）。48-74 岁年龄组的 ICER 为 5600 欧元/YOLS，46-74 岁年龄组的 ICER 为 5600 欧元/YOLS。
降低筛查起始年龄可以使更多的乳腺癌死亡得到预防，因此女性可以从中受益。更早开始常规乳腺癌筛查也是具有成本效益的。由于在两个检查的场景中，预计的额外危害数量相对较小，且 ICER 的差异也不大，因此引入两个额外的筛查周期是合理的。
