Health Equity and Decision Sciences Research Laboratory, National Institute on Minority Health and Health Disparities (NIMHD) Intramural Research Program (IRP), National Institutes of Health, Bethesda, MD, 20892, USA.
Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA.
J Gen Intern Med. 2024 Feb;39(3):428-439. doi: 10.1007/s11606-023-08518-4. Epub 2023 Nov 27.
Guidelines recommend shared decision-making (SDM) around mammography screening for women ≥ 75 years old.
To use microsimulation modeling to estimate the lifetime benefits and harms of screening women aged 75, 80, and 85 years based on their individual risk factors (family history, breast density, prior biopsy) and comorbidity level to support SDM in clinical practice.
DESIGN, SETTING, AND PARTICIPANTS: We adapted two established Cancer Intervention and Surveillance Modeling Network (CISNET) models to evaluate the remaining lifetime benefits and harms of screening U.S. women born in 1940, at decision ages 75, 80, and 85 years considering their individual risk factors and comorbidity levels. Results were summarized for average- and higher-risk women (defined as having breast cancer family history, heterogeneously dense breasts, and no prior biopsy, 5% of the population).
Remaining lifetime breast cancers detected, deaths (breast cancer/other causes), false positives, and overdiagnoses for average- and higher-risk women by age and comorbidity level for screening (one or five screens) vs. no screening per 1000 women.
Compared to stopping, one additional screen at 75 years old resulted in six and eight more breast cancers detected (10% overdiagnoses), one and two fewer breast cancer deaths, and 52 and 59 false positives per 1000 average- and higher-risk women without comorbidities, respectively. Five additional screens over 10 years led to 23 and 31 additional breast cancer cases (29-31% overdiagnoses), four and 15 breast cancer deaths avoided, and 238 and 268 false positives per 1000 average- and higher-risk screened women without comorbidities, respectively. Screening women at older ages (80 and 85 years old) and high comorbidity levels led to fewer breast cancer deaths and a higher percentage of overdiagnoses.
Simulation models show that continuing screening in women ≥ 75 years old results in fewer breast cancer deaths but more false positive tests and overdiagnoses. Together, clinicians and 75 + women may use model output to weigh the benefits and harms of continued screening.
指南建议对 75 岁及以上女性进行乳房 X 光筛查的共同决策。
使用微观模拟模型来估计基于个体风险因素（家族史、乳房密度、既往活检）和合并症水平对 75 岁、80 岁和 85 岁女性进行筛查的终生获益和危害，以支持临床实践中的共同决策。
设计、地点和参与者：我们改编了两个已建立的癌症干预和监测建模网络（CISNET）模型，以评估在决策年龄为 75 岁、80 岁和 85 岁时，考虑到个体风险因素和合并症水平，美国 1940 年出生的女性进行筛查的终生获益和危害。结果总结了平均风险和高风险女性（定义为具有乳腺癌家族史、异质性致密乳房和无既往活检史，占人口的 5%）的情况。
按年龄和合并症水平，每 1000 名女性中筛查（一次或五次筛查）与不筛查相比，平均风险和高风险女性的剩余终生乳腺癌检出数、死亡数（乳腺癌/其他原因）、假阳性和过度诊断数。
与停止筛查相比，75 岁时多进行一次筛查，无合并症的平均风险和高风险女性中分别多检出 6 例和 8 例乳腺癌（过度诊断率为 10%），少发生 1 例和 2 例乳腺癌死亡，多发生 52 例和 59 例假阳性；10 年内多进行 5 次筛查，无合并症的平均风险和高风险筛查女性中分别多检出 23 例和 31 例乳腺癌（过度诊断率为 29%-31%），少发生 4 例和 15 例乳腺癌死亡，多发生 238 例和 268 例假阳性。对年龄较大（80 岁和 85 岁）和合并症水平较高的女性进行筛查，可减少乳腺癌死亡人数，但过度诊断的比例较高。
模拟模型显示，继续对 75 岁及以上女性进行筛查可减少乳腺癌死亡人数，但会导致更多的假阳性检查和过度诊断。临床医生和 75 岁以上的女性可以一起使用模型输出来权衡继续筛查的获益和危害。
