Biennial Mammograms After 75 Cost-Effective, but Benefit Is Limited

(Reuters Health) – While it may be cost-effective for women to get biennial screening mammograms up to age 80 years, it only averts a small number of deaths, a recent study suggests.

Researchers examined data from the Surveillance, Epidemiology, and End Results (SEER) to estimate the incidence of ductal carcinoma in situ (DCIS) and invasive breast cancer among women aged 65 to 90; calculations assumed that DCIS was associated with a 1.9-fold higher risk of a subsequent invasive breast cancer diagnosis. Researchers also used Medicare records linked to the SEER database to estimate healthcare costs for the initial year of breast cancer treatment, subsequent years, and for the final year before any breast cancer deaths.

Continuing biennial screening mammograms through age 80 instead of stopping at 75 would prevent 1.7 breast cancer deaths for every 1,000 screened women with a Charleston comorbidity score (CCS) of 0, researchers estimated. This dropped to 1.4 deaths per 1,000 with a CCS of 1, and 1.0 death for every 1,000 women with a CCS of 2.

Annual screening wasn’t cost-effective after age 75, researchers report in the Annals of Internal Medicine. Continuing biennial screening through age 80 was cost effective. Researchers estimated this would cost $54,000 per quality-adjusted life year (QALY) with a CSS of 0, $65,000 per QALY with a CSS of 1, and $85,000 per QALY with a CSS of 2 or higher.

“The cost-effectiveness is much lower for annual mammography for several reasons because the number of false positive mammograms – which engender need for biopsy and cause a small loss of quality of life – are much, much higher per case of invasive breast cancer discovered or number of breast cancer deaths averted, compared to what we see with biennial mammography,” said lead study author Dr. John Schousboe of the Park Nicollet Clinic and HealthPartners Institute in Minneapolis, Minnesota.

In addition, “the number of invasive breast cancer cases caught at an early stage is only very slightly better with annual versus biennial mammography,” Dr. Schousboe, also an adjunct assistant professor in the division of health policy and management at the University of Minnesota, said by email.

For annual mammography, the burden of overdiagnosis exceeded the number of breast cancer deaths averted by nearly two-fold.

False positive screening mammograms resulted in 14.4 biopsies per 1,000 women screened with CCS scores of 0, 16.7 biopsies per 1,000 women with CCS scores of 1, and 20.3 biopsies per 1,000 women with CCS scores of 2 or higher.

Raising the age to 80, from 75, to stop annual screening mammograms cost more than $100,000 per QALY gained at all comorbidity scores, the study also found.

One limitation of the study, the authors note, is that the lack of randomized controlled trials on screening mammography after age 75 required them to estimate the shift of breast cancer stage with screening in order to calculate the potential impact on survival and the costs of care.

“I still believe that women with a ten-year life expectancy – meaning in their 70’s and in good health – should seek screening,” said Dr. Otis W. Brawley, a professor of oncology and epidemiology at Johns Hopkins University in Baltimore and author of an editorial accompanying the study.

“It is not appreciated that most of the studies in mammography have looked at women aged 50 to 70,” Dr. Brawley said by email. “A third of all women dying of breast cancer are diagnosed after age 70.”

SOURCE: and Annals of Internal Medicine, online November 22, 2021.

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