Comorbidity and screening outcomes among older women undergoing mammography

项目摘要 乳腺癌是老年妇女癌症死亡的主要原因，筛查性乳房X光检查已证明， 有效降低50-69岁妇女的乳腺癌死亡率。然而，筛选 乳房X光检查尚未被证明对70岁及以上的妇女有益，并缩短了预期寿命 随着年龄的增长，筛查获益的潜在机会减少，并可能增加伤害的风险， 往往是即时的。筛查性乳房X光检查的随机试验不能提供答案，因为 试验排除了75岁以上的妇女和有显著合并症的妇女。为了解决这一临床和 作为一个政策难题，该提案创新性地利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集-和基于医疗保险索赔的 数据，以确定老年妇女筛查后的后果。该建议还适用于模拟 建模以比较年龄增长、共病和 功能状态我们将使用来自351，566名年龄在66岁及以上的多种族女性的数据， 1998年至2016年期间在BCSC进行筛查性乳房X光检查。这项大规模的研究使评估 通过纳入预期寿命为10年的女性亚组， 和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 结果，包括收益和危害，在10年的筛查过程中， 不同年龄、合并症和功能状态的妇女。2)确定10年风险 各年龄段接受乳房X光检查的老年妇女的死亡率， 功能状态和并发症。3)评价筛查性乳腺X射线摄影的比较有效性 在老年妇女中使用模拟模型的策略， status.为了优化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、合并症和功能状态进行筛查性乳房X光检查的益处和危害， 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组， 从筛查乳房X光检查，我们的建议直接谈到国家癌症研究所的精确癌症 筛选倡议。

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.