Xabier García-Albéniz, MD, PhD; Miguel A. Hernán, MD, DrPH; Roger W. Logan, PhD; Mary Price, PhD; Katrina Armstrong, MD, MSCE; John Hsu, MD, MBA, MSCE
Grant Support: By grants K99-CA207730, P01-CA134294, R01-CA164023, and R01-HS023128 from the National Institutes of Health.
Disclosures: Dr. Hsu reports grants from the National Institutes of Health and the Agency for Healthcare Research and Quality during the conduct of the study; other support from the American Association for the Advancement of Science, the University of California, DaVita, Sidley Austin LLP, Delta Health Alliance, and Community Servings outside the submitted work; and employment at Massachusetts General Hospital, which provides medical care and cancer screening for Medicare beneficiaries. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1199.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement: Study protocol: See the Appendix. Statistical code: Available from Dr. García-Albéniz (e-mail, email@example.com). Data set: Available from the Centers for Medicare & Medicaid Services (www.cms.gov).
Corresponding Author: Xabier García-Albéniz, MD, PhD, Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. García-Albéniz, Hernán, and Logan: Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115.
Drs. Price and Hsu: Mongan Institute, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.
Dr. Armstrong: Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.
Author Contributions: Conception and design: X. García-Albéniz, M.A. Hernán, J. Hsu.
Analysis and interpretation of the data: X. García-Albéniz, M.A. Hernán, J. Hsu.
Drafting of the article: X. García-Albéniz, M.A. Hernán.
Critical revision of the article for important intellectual content: X. García-Albéniz, M.A. Hernán, K. Armstrong, J. Hsu.
Final approval of the article: X. García-Albéniz, M.A. Hernán, R.W. Logan, M. Price, K. Armstrong, J. Hsu.
Statistical expertise: X. García-Albéniz, M.A. Hernán, R.W. Logan.
Obtaining of funding: X. García-Albéniz, M.A. Hernán, J. Hsu.
Administrative, technical, or logistic support: R.W. Logan, M. Price, J. Hsu.
Collection and assembly of data: R.W. Logan, M. Price, J. Hsu.
Randomized trials have shown that initiating breast cancer screening between ages 50 and 69 years and continuing it for 10 years decreases breast cancer mortality. However, no trials have studied whether or when women can safely stop screening mammography. An estimated 52% of women aged 75 years or older undergo screening mammography in the United States.
To estimate the effect of breast cancer screening on breast cancer mortality in Medicare beneficiaries aged 70 to 84 years.
Large-scale, population-based, observational study of 2 screening strategies: continuing annual mammography, and stopping screening.
U.S. Medicare program, 2000 to 2008.
1 058 013 beneficiaries aged 70 to 84 years who had a life expectancy of at least 10 years, had no previous breast cancer diagnosis, and underwent screening mammography.
Eight-year breast cancer mortality, incidence, and treatments, plus the positive predictive value of screening mammography by age group.
In women aged 70 to 74 years, the estimated difference in 8-year risk for breast cancer death between continuing and stopping screening was −1.0 (95% CI, −2.3 to 0.1) death per 1000 women (hazard ratio, 0.78 [CI, 0.63 to 0.95]) (a negative risk difference favors continuing). In those aged 75 to 84 years, the corresponding risk difference was 0.07 (CI, −0.93 to 1.3) death per 1000 women (hazard ratio, 1.00 [CI, 0.83 to 1.19]).
The available Medicare data permit only 8 years of follow-up after screening. As with any study using observational data, the estimates could be affected by residual confounding.
Continuing annual breast cancer screening past age 75 years did not result in substantial reductions in 8-year breast cancer mortality compared with stopping screening.
National Institutes of Health.
García-Albéniz X, Hernán MA, Logan RW, et al. Continuation of Annual Screening Mammography and Breast Cancer Mortality in Women Older Than 70 Years. Ann Intern Med. 2020;172:381–389. [Epub ahead of print 25 February 2020]. doi: https://doi.org/10.7326/M18-1199
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Published: Ann Intern Med. 2020;172(6):381-389.
Published at www.annals.org on 25 February 2020
Breast Cancer, Cancer Screening/Prevention, Hematology/Oncology, High Value Care, Prevention/Screening.
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