Is screening mammography beyond age 75 years cost-effective?
USA: Biennial screening mammography is cost-effective to healthy women up to 80 years old but not annual mammography, according to a recent study. However, the absolute number of deaths avoided is small, particularly for women with comorbidities.
The study, published in the Annals of Internal Medicine, suggests that women considering screening after 80 years of age should weigh the potential harms of overdiagnosis compared to the potential benefit of averting death from breast cancer.
Prior to this study, it was not clear that for how long should older women continue to receive breast screening. Most guidelines suggest stopping at age 75, but the cost-effectiveness of screening mammography beyond age 75 years remains unclear. To clarify the same, John T. Schousboe, University of Minnesota, Minneapolis, Minnesota (J.T.S.), and colleagues aimed to estimate the benefits, harms, and cost-effectiveness of extending mammography to age 80, 85, or 90 years according to comorbidity burden in a Markov microsimulation model.
For the study, the researchers obtained information from the SEER (Surveillance, Epidemiology, and End Results) program and Breast Cancer Surveillance Consortium. It included U.S. women aged 65 to 90 years in groups defined by Charlson comorbidity score (CCS). Interventions included screening mammography to age 75, 80, 85, or 90 years.
Outcome measures included breast cancer death, survival, and costs.
Key findings include:
- Extending biennial mammography from age 75 to 80 years averted 1.7, 1.4, and 1.0 breast cancer deaths and increased days of life gained by 5.8, 4.2, and 2.7 days per 1000 women for comorbidity scores of 0, 1, and 2, respectively.
- Annual mammography beyond age 75 years was not cost-effective, but extending biennial mammography to age 80 years was ($54 000, $65 000, and $85 000 per quality-adjusted life-year [QALY] gained for women with CCSs of 0, 1, and ≥2, respectively).
- Overdiagnosis cases were double the number of deaths averted from breast cancer.
- Costs per QALY gained were sensitive to changes in invasive cancer incidence and shift of breast cancer stage with screening mammography.
"Our study may inform new screening mammography guidelines for older women and supports some current guidelines regarding screening of women after age 75 years," the researchers wrote.
To conclude, although annual mammography is not cost-effective, biennial screening mammography to age 80 years is; however, the absolute number of deaths averted is small, especially for women with comorbidities.
Reference:
The study titled, "Cost-Effectiveness of Screening Mammography Beyond Age 75 Years: A Cost-Effectiveness Analysis," is published in Annals of Internal Medicine.
DOI: https://www.acpjournals.org/doi/10.7326/M20-8076
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