Basmadjian Robert B, Ruan Yibing, Hutchinson John M, Warkentin Matthew T, Alagoz Oguzhan, Coldman Andrew, Brenner Darren R
Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
J Med Screen. 2025 Mar;32(1):35-43. doi: 10.1177/09691413241267845. Epub 2024 Aug 6.
To quantify the resource use of revising breast cancer screening guidelines to include average-risk women aged 40-49 years across Canada from 2024 to 2043 using a validated microsimulation model.
OncoSim-Breast microsimulation platform was used to simulate the entire Canadian population in 2015-2051.
We compared resource use between current screening guidelines (biennial screening ages 50-74) and alternate screening scenarios, which included annual and biennial screening for ages 40-49 and ages 45-49, followed by biennial screening ages 50-74. We estimated absolute and relative differences in number of screens, abnormal screening recalls without cancer, total and negative biopsies, screen-detected cancers, stage of diagnosis, and breast cancer deaths averted.
Compared with current guidelines in Canada, the most intensive screening scenario (annual screening ages 40-49) would result in 13.3% increases in the number of screens and abnormal screening recalls without cancer whereas the least intensive scenario (biennial screening ages 45-49) would result in a 3.4% increase in number of screens and 3.8% increase in number of abnormal screening recalls without cancer. More intensive screening would be associated with fewer stage II, III, and IV diagnoses, and more breast cancer deaths averted.
Revising breast cancer screening in Canada to include average-risk women aged 40-49 would detect cancers earlier leading to fewer breast cancer deaths. To realize this potential clinical benefit, a considerable increase in screening resources would be required in terms of number of screens and screen follow-ups. Further economic analyses are required to fully understand cost and budget implications.
使用经过验证的微观模拟模型，量化2024年至2043年在加拿大修订乳腺癌筛查指南以纳入40 - 49岁平均风险女性的资源使用情况。
OncoSim - Breast微观模拟平台用于模拟2015年至2051年的整个加拿大人口。
我们比较了当前筛查指南（50 - 74岁每两年筛查一次）与替代筛查方案之间的资源使用情况，替代筛查方案包括40 - 49岁每年和每两年筛查一次以及45 - 49岁每两年筛查一次，随后50 - 74岁每两年筛查一次。我们估计了筛查次数、无癌症的异常筛查召回、活检总数和阴性活检、筛查发现的癌症、诊断阶段以及避免的乳腺癌死亡人数的绝对和相对差异。
与加拿大当前指南相比，最密集的筛查方案（40 - 49岁每年筛查）将使筛查次数和无癌症的异常筛查召回增加13.3%，而最不密集的方案（45 - 49岁每两年筛查）将使筛查次数增加3.4%，无癌症的异常筛查召回增加3.8%。更密集的筛查将与II期、III期和IV期诊断减少以及避免更多乳腺癌死亡相关。
在加拿大修订乳腺癌筛查指南以纳入40 - 49岁平均风险女性将更早发现癌症，从而减少乳腺癌死亡人数。为实现这一潜在的临床益处，在筛查次数和筛查后续方面将需要大幅增加筛查资源。需要进一步的经济分析以充分了解成本和预算影响。
