COMORBIDITY AND SCREENING OUTCOMES AMONG OLDER WOMEN UNDERGOING MAMMOGRAPHY

项目摘要 乳腺癌是老年女性癌症死亡的主要原因，筛查乳房X光检查已证明 有效降低50-69岁女性的乳腺癌死亡率。然而，筛查 乳房X光检查尚未被证明对70岁及以上和预期寿命缩短的女性有益 随着年龄的增长，筛查受益的潜在机会会降低，并可能增加损害的风险，这 往往是即刻发生的。筛查乳房X光检查的随机试验不能提供答案，因为 试验排除了75岁以上的女性和有严重合并症的女性。为了解决这一临床和 政策难题，该提案创新地使用了乳腺癌监测联盟的数据 (BCSC)-全国最大的乳腺癌监测数据收集-以及基于联邦医疗保险的索赔 用来确定老年妇女筛查结果的数据。该提案还应用了模拟 建模以比较不同年龄、合并疾病和疾病水平筛查的好处和坏处 功能状态。我们将使用351,566名年龄在66岁及以上的多民族女性的数据，她们经历了 1998年至2016年在BCSC进行的乳房X光检查。这项大规模研究使评估成为可能 通过纳入预期寿命为10年的妇女子组来评估筛查的好处和坏处 以及预期寿命有限的女性。我们的具体目标是：1)确定筛查的累积风险 10年来对老年人进行乳房X光检查的结果，包括益处和危害 不同年龄、合并症和功能状态的妇女。2)确定以下项目的10年风险 在接受筛查乳房X光检查的老年妇女中， 合并症和功能状态。3)评价筛查乳房X光检查的比较效果 使用模拟模型的老年妇女在年龄、合并症和功能水平上的策略 状态。为了最佳地向老年妇女提供高质量的保健服务，迫切需要比较 根据年龄、合并症和功能状态筛查乳房X光检查的好处和坏处 是预期寿命的关键预测因素。通过确定最有可能和最不可能受益的老年妇女亚群 通过筛查乳房X光检查，我们的建议直接与国家癌症研究所的精确癌症 放映倡议。

Project Summary Breast cancer is a major cause of cancer death in older women and screening mammography has proven to be effective in reducing breast cancer mortality in women aged 50-69 years. However, screening mammography has not been proven beneficial in women aged 70 and older and diminished life expectancy with aging decreases the potential chance of screening benefit and likely increases the risk of harms, which tend to be immediate. Randomized trials of screening mammography cannot provide the answers because the trials excluded women older than age 75 and those with significant comorbidity. To address this clinical and policy conundrum, the proposal makes innovative use of data from the Breast Cancer Surveillance Consortium (BCSC)—the largest collection of breast cancer surveillance data in the nation— and Medicare claims-based data to determine the consequences following screening in older women. The proposal also applies simulation modeling to compare benefits and harms of screening across levels of advancing age, comorbid illness and functional status. We will use data from 351,566 multi-ethnic women aged 66 years and older who underwent screening mammography in the BCSC between 1998 and 2016. This large-scale study enables the evaluation of benefits and harms of screening by including subgroups of women with favorable 10-year life expectancy and women with limited life expectancy. Our specific aims are: 1) Determine cumulative risk of screening outcomes, including benefits and harms, over the course of 10 years of screening mammography among older women across levels of advancing age, comorbidity and functional status. 2) Determine 10-year risk of mortality among older women undergoing screening mammography across levels of advancing age, comorbidity and functional status. 3) Evaluate comparative effectiveness of screening mammography strategies in older women using a simulation model across levels of advancing age, comorbidity and functional status. To optimize the delivery of high quality health care to older women, there is an urgent need to compare the benefits and harms of screening mammography according to age, comorbidity and functional status, which are key predictors of life expectancy. By identifying subgroups of older women most and least likely to benefit from screening mammography, our proposal speaks directly to the National Cancer Institute’s precision cancer screening initiative.