Warmerdam P G, de Koning H J, Boer R, Beemsterboer P M, Dierks M L, Swart E, Robra B P
Department of Public Health, Erasmus University Rotterdam, The Netherlands.
J Epidemiol Community Health. 1997 Apr;51(2):180-6. doi: 10.1136/jech.51.2.180.
To estimate quantitatively the impact of the quality of mammographic screening (in terms of sensitivity and specificity) on the effects and costs of nationwide breast cancer screening.
Three plausible "quality" scenarios for a biennial breast cancer screening programme for women aged 50-69 in Germany were analysed in terms of costs and effects using the Microsimulation Screening Analysis model on breast cancer screening and the natural history of breast cancer. Firstly, sensitivity and specificity in the expected situation (or "baseline" scenario) were estimated from a model based analysis of empirical data from 35,000 screening examinations in two German pilot projects. In the second "high quality" scenario, these properties were based on the more favourable diagnostic results from breast cancer screening projects and the nationwide programme in The Netherlands. Thirdly, a worst case, "low quality" hypothetical scenario with a 25% lower sensitivity than that experienced in The Netherlands was analysed.
The epidemiological and social situation in Germany in relation to mass screening for breast cancer.
In the "baseline" scenario, an 11% reduction in breast cancer mortality was expected in the total German female population, ie 2100 breast cancer deaths would be prevented per year. It was estimated that the "high quality" scenario, based on Dutch experience, would lead to the prevention of an additional 200 deaths per year and would also cut the number of false positive biopsy results by half. The cost per life year gained varied from Deutsche mark (DM) 15,000 on the "high quality" scenario to DM 21,000 in the "low quality" setting.
Up to 20% of the total costs of a screening programme can be spent on quality improvement in order to achieve a substantially higher reduction in mortality and reduce undesirable side effects while retaining the same cost effectiveness ratio as that estimated from the German data.
定量评估乳腺钼靶筛查质量（从灵敏度和特异度方面）对全国乳腺癌筛查的效果和成本的影响。
采用乳腺癌筛查和乳腺癌自然史微观模拟筛查分析模型，从成本和效果方面分析了德国针对50 - 69岁女性的两年一次乳腺癌筛查项目的三种看似合理的“质量”情景。首先，根据对德国两个试点项目35000次筛查检查的实证数据进行的模型分析，估算预期情况下（或“基线”情景）的灵敏度和特异度。在第二个“高质量”情景中，这些特性基于荷兰乳腺癌筛查项目和全国性项目更有利的诊断结果。第三，分析了一个最坏情况的“低质量”假设情景，其灵敏度比荷兰的情况低25%。
德国与乳腺癌大规模筛查相关联的流行病学和社会状况。
在“基线”情景中，预计德国女性总人口的乳腺癌死亡率将降低11%，即每年可预防2100例乳腺癌死亡。据估计，基于荷兰经验的“高质量”情景每年将额外预防2 hundred deaths and would also cut the number of false positive biopsy results by half. 每获得一个生命年（life year）的成本从“高质量”情景下的15000德国马克到“低质量”情景下的21000德国马克不等。
筛查项目总成本的20%可用于提高质量，以便在保持与德国数据估计的相同成本效益比的同时，大幅提高死亡率降低幅度并减少不良副作用。 （注：原文中“2 hundred deaths”表述有误，推测应为“200 deaths”，译文按此修正翻译）
