A recent study – comparing various scenarios – has suggested that annual breast cancer screening from 40 to 79 shows the greatest reduction in mortality, reports Medpage Today.
Using Cancer Intervention and Surveillance Modelling Network (CISNET) estimates of breast cancer screening outcomes published in 2009, 2016 and 2023, mortality was reduced by 41.7% with annual screening starting at 40 and continuing up to 79, reported Debra Monticciolo, MD, of Dartmouth-Hitchcock Medical Centre in New Hampshire, and colleagues.
This was in comparison with biennial screening at 50-74, which reduced mortality by 25.4%; biennial screening at 40-74, which reduced mortality by 30%; and annual screening at 40-74, which reduced mortality by 37%, they noted in the journal Radiology.
Annual screening from 40-79 also averted the most breast cancer deaths (11.5 per 1 000 screened), and gained the most life-years (230 per 1 000 screened) versus the other screening scenarios (range 6.7-10.3 per 1 000 and 121-217 per 1 000, respectively).
And while false-positive screening results and benign biopsies were highest with annual screening from 40-79, “these risks are lowest on a per-examination basis with this scenario, suggesting these risks are manageable”, Monticciolo and team wrote.
Changing the newest US Preventive Services Task Force (USPSTF) draft recommendation of biennial screening from 40-74 to annual screening up to age 79 “would markedly improve mortality reduction”, they concluded.
“The goal of any cancer screening programme is to avert untimely cancer deaths. Thus, annual breast cancer screening starting at 40 and extending to 79 and beyond is the best way to achieve that goal.”
In an accompanying editorial, Bonnie Joe, MD, PhD, of the University of California-San Francisco, said: “It is disappointing that the USPSTF did not come out in full support of annual screening, particularly if their goal is to reduce healthcare disparities.”
Despite evidence like the results from this study, “the USPSTF stuck with a biennial screening interval”, she wrote. “This seems counter to the goal of reducing healthcare disparities, particularly because the USPSTF highlights concern about more aggressive cancers in younger people and in black women.”
Regarding estimates for black women, Monticciolo and colleagues determined that annual screening up to 79 showed the highest breast cancer mortality reduction, breast cancer deaths averted, and life-years gained.
Based on 2023 CISNET estimates for digital breast tomosynthesis, mortality reduction in black women was 39.6% with annual screening at ages 40-79, compared with 24.1% with biennial screening from 50-74 and 29.9% with biennial screening from 40-74.
Moreover, the number of breast cancer deaths averted and life-years gained would be 42% higher for black women than for non-black women with annual screening from 40-79.
For this study, the researchers assessed four different screening scenarios: biennial screening at ages 50-74 (the 2009 and 2016 USPSTF recommendations), biennial screening at 40-74 (2023 USPSTF draft recommendation), annual screening at ages 40-74, and annual screening at 40-79.
The authors noted that their study had limitations. For example, CISNET model estimates for 2016 only went to 74 and 2023 estimates only went to age 79.
Therefore, they said they could only approximate the current American College of Radiology, Society of Breast Imaging, and National Comprehensive Cancer Network recommendations of annual screening starting at 40 and extending beyond 79.
Study details
Outcomes of Breast Cancer Screening Strategies Based on Cancer Intervention and Surveillance Modelling Network Estimates
Debra Monticciolo, Edward Hendrick, Mark Helvie.
Published in Radiology on 20 February 2024
Abstract
Background
There is ongoing debate about recommendations for breast cancer screening strategies, specifically regarding the frequency of screening and the age at which to initiate screening.
Purpose
To compare estimates of breast cancer screening outcomes published by the Cancer Intervention and Surveillance Modelling Network (CISNET) to understand the benefits and risks of different screening scenarios.
Materials and Methods
Modeling estimates published by CISNET are based on hypothetical cohorts in the United States and compare women, starting at 40 years of age, who do and do not undergo breast cancer screening with mammography. The four scenarios assessed in this study, of multiple possible scenarios, were biennial screening ages 50–74 years (2009 and 2016 US Preventive Services Task Force [USPSTF] recommendations), biennial screening ages 40–74 years (2023 USPSTF draft recommendation), annual screening ages 40–74 years, and annual screening ages 40–79 years. For each scenario, CISNET estimates of median lifetime benefits were compared. Risks that included false-positive screening results per examination and benign biopsies per examination were also calculated and compared.
Results
Estimates from CISNET 2023 showed that annual screening ages 40–79 years improved breast cancer mortality reduction compared with biennial screening ages 50–74 years and biennial screening ages 40–74 years (41.7%, 25.4%, and 30%, respectively). Annual screening ages 40–79 years averted the most breast cancer deaths (11.5 per 1000) and gained the most life-years (230 per 1000) compared with other screening scenarios (range, 6.7–11.5 per 1000 and 121–230 per 1000, respectively). False-positive screening results per examination were less than 10% for all screening scenarios (range, 6.5%–9.6%) and lowest for annual screening ages 40–79 years (6.5%). Benign biopsies per examination were less than 1.33% for all screening scenarios (range, 0.88%–1.32%) and lowest for annual screening ages 40–79 years (0.88%).
Conclusion
CISNET 2023 modelling estimates indicate that annual breast cancer screening starting at 40 years of age provides the greatest benefit to women and the least risk per examination.
See more from MedicalBrief archives:
Breast cancer screening does not reduce mortality
New screening 40% better at finding breast cancer
False positive readings for 50% of 3D mammograms over a decade of screening
Under-35s have greater risk of breast cancer spreading — Meta-analysis