Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms.
Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms.
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DOI：
10.7326/0003-4819-151-10-200911170-00010
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发表时间：
2009-11-17
影响因子：
39.2
通讯作者：
Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network
中科院分区：
文献类型：
--
作者：
Mandelblatt JS;Cronin KA;Bailey S;Berry DA;de Koning HJ;Draisma G;Huang H;Lee SJ;Munsell M;Plevritis SK;Ravdin P;Schechter CB;Sigal B;Stoto MA;Stout NK;van Ravesteyn NT;Venier J;Zelen M;Feuer EJ;Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network
尽管乳房X光检查的试验和广泛使用，最佳筛查政策是有争议的。六个模型使用共同的数据元素来评估美国的筛查策略。这些模型使用了关于特定年龄发病率、竞争死亡率、乳房X线摄影特征和治疗效果的国家数据。一个当代人口队列在他们的一生中进行了跟踪。我们从社会的角度进行分析。我们评估了20种筛查策略，每年或每两年应用不同的开始和停止年龄。乳房X线照片的数量、乳腺癌死亡率降低或生命年增加[LYG]（与无筛查相比）、假阳性、不必要的活检和过度诊断。这6个模型产生了一致的筛选策略排名。每两年进行一次的筛查平均保持了每年筛查的81%（策略和模型范围为67-99%）的益处，假阳性数量几乎减少了一半。从50岁到69岁每两年进行一次筛查，与不进行筛查相比，乳腺癌死亡率降低了16.5%（范围15%-23%）。在40岁（与50岁相比）开始两年一次的筛查，死亡率额外降低3%（范围1%-6%），消耗更多的资源，产生更多的假阳性。在所有模型中，69岁以后每两年进行一次筛查会使死亡率进一步降低，但过度诊断在年龄较大时增加最多。不同的检测灵敏度或治疗模式不会改变结论。结果不包括假阳性、早期诊断知识或接受不必要治疗的发病率。两年一次的筛查实现了年度筛查的大部分益处，但危害较小。关于最佳战略的决定取决于项目和个人目标以及对利益、危害和资源考虑的重视程度。
Despite trials of mammography and widespread use, optimal screening policy is controversial. Six models use common data elements to evaluate US screening strategies. The models use national data on age-specific incidence, competing mortality, mammography characteristics and treatment effects. A contemporary population cohort followed over their lifetimes. We use a societal perspective for analysis. We evaluate 20 screening strategies with varying initiation and cessation ages applied annually or biennially. Number of mammograms, breast cancer mortality reduction or life years gained [LYG] (vs. no screening), false positives, unnecessary biopsies and over-diagnosis. The 6 models produce consistent rankings of screening strategies. Screening biennially maintains an average of 81% (range across strategies and models 67–99%) of the benefit of annual screening with almost half the number of false positives. Screening biennially from ages 50 to 69 achieves a median 16.5% (range 15%–23%) breast cancer mortality reduction vs. no screening. Initiating biennial screening at age 40 (vs. 50) reduces mortality by an additional 3% (range 1%–6%), consumes more resources and yields more false positives. Biennial screening after age 69 yields some additional mortality reduction in all models but over-diagnosis increases most substantially at older ages. Varying test sensitivity or treatment patterns do not change conclusions. Results do not include morbidity from false positives, knowledge of earlier diagnosis or under-going unnecessary treatment. Biennial screening achieves most of the benefit of annual screening with less harm. Decisions about the best strategy depend on program and individual objectives and the weight placed on benefits, harms and resource considerations.
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影响因子：
254.7
作者：
Jemal, Ahmedin;Siegel, Rebecca;Thun, Michael J.
通讯作者：
Thun, Michael J.
影响因子：
3.5
作者：
Bonomi, Amy E.;Boudreau, Denise M.;Seger, Deb
通讯作者：
Seger, Deb
影响因子：
2.3
作者：
Feuer, EJ;Etzioni, R;Mariotto, A
通讯作者：
Mariotto, A
DOI：
10.1093/jncimonographs/lgj013
发表时间：
2006-01-01
期刊：
Journal of the National Cancer Institute. Monographs
影响因子：
--
作者：
Clarke, Lauren D;Plevritis, Sylvia K;Feuer, Eric J
通讯作者：
Feuer, Eric J
影响因子：
10.3
作者：
Elmore, JG;Reisch, LM;Fletcher, SW
通讯作者：
Fletcher, SW