Identifying Equitable Screening Mammography Strategies for Black Women in the United States Using Simulation Modeling.
Identifying Equitable Screening Mammography Strategies for Black Women in the United States Using Simulation Modeling.
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DOI：
10.7326/m20-6506
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发表时间：
2021-12
影响因子：
39.2
通讯作者：
Mandelblatt, Jeanne S.
中科院分区：
文献类型：
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作者：
Chapman, Christina Hunter;Schechter, Clyde B.;Cadham, Christopher J.;Trentham-Dietz, Amy;Gangnon, Ronald E.;Jagsi, Reshma;Mandelblatt, Jeanne S.
筛查乳腺X线摄影指南没有明确考虑乳腺癌流行病学，治疗和生存的种族差异。比较黑人妇女与白色妇女在现行指南下筛查策略的权衡。一个已建立的癌症干预和监测建模网络模型使用针对亚型分布、乳腺密度、乳房X光检查性能、年龄、分期和亚型特异性治疗效果以及非乳腺癌死亡率的种族特异性输入来模拟筛查结果。美国的1980年美国黑人和白色女性的出生队列。筛查策略，直到74岁，不同的开始年龄和间隔。结果包括受益（生命年增加，乳腺癌死亡避免，死亡率降低），危害（乳房X线检查，假阳性和过度诊断），以及按种族划分的利益与危害比（权衡）。我们评估了效率（每单位效益的资源），死亡率差距的减少和权衡的公平性。黑人妇女的公平战略被定义为那些权衡最接近的基准值筛选白色妇女每两年从50-74。45-74岁的两年一次的筛查对黑人妇女最有效，而40-74岁的两年一次的筛查最公平。在黑人与白色妇女中提前10年开始筛查，将黑人与白色妇女的死亡率差异降低了57%，两个人群的生命年增加/乳房X线检查结果相似。选择最公平的战略是敏感的假设差异在真实的世界的治疗效果：治疗效果较低的是黑人妇女，更密集的黑人妇女可以筛选之前的权衡达不到那些经验丰富的白色妇女。单一型号。在40岁的黑人妇女中开始两年一次的筛查可以减少乳腺癌死亡率的差异，并产生与50-74岁的白色妇女两年一次筛查的利弊相当的利益-危害比。
Screening mammography guidelines do not explicitly consider racial differences in breast cancer epidemiology, treatment, and survival. To compare tradeoffs of screening strategies in Black women to those of White women screened under current guidelines. An established Cancer Intervention and Surveillance Modeling Network model simulated screening outcomes using race-specific inputs for subtype distribution, breast density, mammogram performance, age-, stage-, and subtype-specific treatment effects, and non-breast cancer mortality. United States. 1980 US birth cohort of Black and White women. Screening strategies until age 74 with varying initiation ages and intervals. Outcomes included benefits (life-years gained, breast cancer deaths averted, and mortality reduction), harms (mammograms, false positives, and overdiagnoses), and benefits-to-harm ratios (tradeoffs) by race. We evaluated efficiency (resources per unit benefit), mortality disparity reduction, and equity in tradeoffs. Equitable strategies for Black women were defined as those with tradeoffs closest to benchmark values for screening White women biennially from 50–74. Biennial screening from 45–74 was the most efficient for Black women, while biennial screening from 40–74 was the most equitable. Initiating screening ten-years earlier in Black vs. White women reduced Black-White mortality disparities by 57% with comparable life-years gained/mammogram for both populations. Selection of the most equitable strategy was sensitive to assumptions about disparities in real world treatment effectiveness: the less effective treatment was for Black women, the more intensively Black women could be screened before tradeoffs fell short of those experienced by White women. Single model. Initiating biennial screening in Black women at age 40 yields reduces breast cancer mortality disparities and yields benefit-to-harm ratios that are comparable to tradeoffs of White women screened biennially from 50–74.