Jeanne Mandelblatt, MD, MPH; Somnath Saha, MD, MPH; Steven Teutsch, MD, MPH; Tom Hoerger, PhD; Albert L. Siu, MD, MSPH; David Atkins, MD, MPH; Jonathan Klein, MD; Mark Helfand, MD, MS; for the Cost Work Group of the U.S. Preventive Services Task Force
Disclaimer: The authors are responsible for the contents of this review, including any clinical recommendations. No statement in this article should be construed as an official position from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, or National Cancer Institute.
Acknowledgments: The authors acknowledge the support and assistance of Kathryn Pyle Krages, AMLS, MA, of the Oregon Health and Science University Evidence-based Practice Center, and Trina McClendon for manuscript preparation.
Grant Support: By contracts 290-97-0018 and 290-97-0011 from the Agency for Healthcare Research and Quality and by grants #U01CA88283 and #KO5 CA96940 from the National Cancer Institute (Dr. Mandelblatt). Dr. Saha is supported by a research career development grant from the Health Services Research and Development Service of the Department of Veterans Affairs.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Jeanne Mandelblatt, MD, MPH, Lombardi Cancer Center, 2233 Wisconsin Avenue, Suite 317, Washington, DC 20007; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Mandelblatt: Lombardi Cancer Center, 2233 Wisconsin Avenue, Suite 317, Washington, DC 20007.
Dr. Saha: Portland Veterans Affairs Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239.
Dr. Teutsch: Merck & Co., PO Box 4, WP39-168, West Point, PA 19486-0004.
Dr. Hoerger: Research Triangle Institute, 3040 Cornwallis Road, Research Triangle Park, NC 27709.
Dr. Siu: Mount Sinai School of Medicine, 1 Gustave L. Levey Place, Box 1070, New York, NY 10029.
Dr. Atkins: Agency for Healthcare Research and Quality, 540 Gaither Road, 6th Floor, Rockville, MD 20850.
Dr. Klein: University of Rochester, 601 Elmwood, #69, Rochester, NY 14642.
Dr. Helfand: Portland Veterans Affairs Medical Center, 3181 SW Sam Jackson Park Road, Portland, OR 97201.
There are few data on the effects of disease biology and competing mortality on the effectiveness of screening women for breast cancer after age 65 years. The authors performed a review to determine the costs and benefits of mammography screening after age 65 years.
Cost-effectiveness articles published between January 1989 and March 2002.
Studies were identified by using MEDLINE and the National Health Service Economic Evaluation Database. The authors included research on screening after age 65 years conducted from a societal or government perspective; reviews and analyses of other technologies were excluded.
115 studies were identified and 10 met inclusion criteria. One study modeled age-dependent assumptions of disease biology. No study fully captured the potential harms of screening, including anxiety associated with false-positive results, overdiagnosis, and previous knowledge of cancer or living longer with the consequences of treatment. Studies differed in the specific strategies compared and in analytic approaches. On average, extending biennial screening to age 75 or 80 years was estimated to cost $34 000 to $88 000 (2002 U.S. dollars) per life-year gained, compared with stopping screening at age 65 years. Two studies suggested that it was more cost-effective to target healthy women than those with several competing risks for death.
Current estimates suggest that biennial breast cancer screening after age 65 years reduces mortality at reasonable costs for women without clinically significant comorbid conditions. More data are needed on disease biology and preferences for benefits and harms in older women.
Table. Summary of Studies on the Cost-Effectiveness of Screening for Breast Cancer after Age 65 Years
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Mandelblatt J, Saha S, Teutsch S, Hoerger T, Siu AL, Atkins D, et al. The Cost-Effectiveness of Screening Mammography beyond Age 65 Years: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. ;139:835–842. doi: 10.7326/0003-4819-139-10-200311180-00011
Download citation file:
Published: Ann Intern Med. 2003;139(10):835-842.
Breast Cancer, Cancer Screening/Prevention, Hematology/Oncology, Prevention/Screening.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use