John T. Schousboe, MD, PhD; Karla Kerlikowske, MD, MS; Andrew Loh, BA; Steven R. Cummings, MD
Acknowledgment: The authors thank the BCSC investigators, participating mammography facilities, and radiologists for the data they provided for this study.
Grant Support: By an unrestricted grant from Eli Lilly and by the Da Costa Family Foundation for Research in Breast Cancer Prevention of the California Pacific Medical Center. Data collection for this work was supported by grants U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, and U01CA70040 from the National Cancer Institute BCSC. The collection of cancer incidence data used in this study was supported by several state public health departments and cancer registries throughout the United States; a full description of these sources can be found at http://breastscreening.cancer.gov/work/acknowledgement.html.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2871.
Reproducible Research Statement:Study protocol, statistical code, and data set: Procedures for requesting these data for research purposes are provided at http://breastscreening.cancer.gov/.
Requests for Single Reprints: John T. Schousboe, MD, PhD, Park Nicollet Institute, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416; e-mail, email@example.com.
Current Author Addresses: Dr. Schousboe: Park Nicollet Institute, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416.
Dr. Kerlikowske: Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Mr. Loh: 342 Beresford Avenue, Redwood City, CA 94062.
Dr. Cummings: California Pacific Medical Center Research Institute Coordinating Center, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107.
Author Contributions: Conception and design: J.T. Schousboe, K. Kerlikowske, S.R. Cummings.
Analysis and interpretation of the data: J.T. Schousboe, K. Kerlikowske, A. Loh, S.R. Cummings.
Drafting of the article: J.T. Schousboe, K. Kerlikowske, A. Loh, S.R. Cummings.
Critical revision of the article for important intellectual content: J.T. Schousboe, K. Kerlikowske, A. Loh.
Final approval of the article: J.T. Schousboe, K. Kerlikowske, A. Loh, S.R. Cummings.
Provision of study materials or patients: J.T. Schousboe, K. Kerlikowske, A. Loh.
Statistical expertise: J.T. Schousboe, K. Kerlikowske.
Obtaining of funding: K. Kerlikowske.
Administrative, technical, or logistic support: J.T. Schousboe, K. Kerlikowske.
Collection and assembly of data: J.T. Schousboe, K. Kerlikowske, A. Loh.
Schousboe JT, Kerlikowske K, Loh A, Cummings SR. Personalizing Mammography by Breast Density and Other Risk Factors for Breast Cancer: Analysis of Health Benefits and Cost-Effectiveness. Ann Intern Med. 2011;155:10-20. doi: 10.7326/0003-4819-155-1-201107050-00003
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Published: Ann Intern Med. 2011;155(1):10-20.
Current guidelines recommend mammography every 1 or 2 years starting at age 40 or 50 years, regardless of individual risk for breast cancer.
To estimate the cost-effectiveness of mammography by age, breast density, history of breast biopsy, family history of breast cancer, and screening interval.
Markov microsimulation model.
Surveillance, Epidemiology, and End Results program, Breast Cancer Surveillance Consortium, and the medical literature.
U.S. women aged 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years with initial mammography at age 40 years and breast density of Breast Imaging Reporting and Data System (BI-RADS) categories 1 to 4.
National health payer.
Mammography annually, biennially, or every 3 to 4 years or no mammography.
Costs per quality-adjusted life-year (QALY) gained and number of women screened over 10 years to prevent 1 death from breast cancer.
Biennial mammography cost less than $100 000 per QALY gained for women aged 40 to 79 years with BI-RADS category 3 or 4 breast density or aged 50 to 69 years with category 2 density; women aged 60 to 79 years with category 1 density and either a family history of breast cancer or a previous breast biopsy; and all women aged 40 to 79 years with both a family history of breast cancer and a previous breast biopsy, regardless of breast density. Biennial mammography cost less than $50 000 per QALY gained for women aged 40 to 49 years with category 3 or 4 breast density and either a previous breast biopsy or a family history of breast cancer. Annual mammography was not cost-effective for any group, regardless of age or breast density.
Mammography is expensive if the disutility of false-positive mammography results and the costs of detecting nonprogressive and nonlethal invasive cancer are considered.
Results are not applicable to carriers of BRCA1 or BRCA2 mutations.
Mammography screening should be personalized on the basis of a woman's age, breast density, history of breast biopsy, family history of breast cancer, and beliefs about the potential benefit and harms of screening.
Eli Lilly, Da Costa Family Foundation for Research in Breast Cancer Prevention of the California Pacific Medical Center, and Breast Cancer Surveillance Consortium.
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Hematology/Oncology, High Value Care, Breast Cancer, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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