ArticleJournal of the National Cancer Institute2014
Benefits, harms, and costs for breast cancer screening after US implementation of digital mammography.
Abstract read
In one paragraph
Article in Journal of the National Cancer Institute, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 5 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
68citing papers in PubMed, 5 pooled it
–field-weighted citation impact
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
68 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Health Economic Evaluations of Breast Cancer Screening Strategies: A Systematic Review Focusing on Methodology and Quality Assessment.Applied health economics and health policy · 2026Pooled it
- Assessing value in health care: using an interpretive classification system to understand existing practices based on a systematic review.BMC health services research · 2019Pooled it
- Risk-reducing medications for primary breast cancer: a network meta-analysis.The Cochrane database of systematic reviews · 2019Pooled it
- Simulation modeling for stratified breast cancer screening - a systematic review of cost and quality of life assumptions.BMC health services research · 2017Pooled it
- Guideline
- Changes in Use, Cost, and Value of Breast Cancer Screening Among Older Women in the US.Journal of general internal medicine · 2026Article
- Outcomes of Density-Targeted Supplemental Breast Magnetic Resonance Imaging Screening by Breast Cancer Risk: Long-Term Health and Economic Considerations.Annals of internal medicine · 2026Article
- Economics of AI and human task sharing for decision making in screening mammography.Nature communications · 2025Article
- An open codebase for enhancing transparency in deep learning-based breast cancer diagnosis utilizing CBIS-DDSM data.Scientific reports · 2024Article
- Early detection of breast cancer through the diagnosis of Nipple Aspirate Fluid (NAF).Clinical proteomics · 2024Review
- A Multicentric, Single Arm, Prospective, Stratified Clinical Investigation to Confirm MammoWave's Ability in Breast Lesions Detection.Diagnostics (Basel, Switzerland) · 2023Article
- Health Benefits and Cost-Effectiveness of Children's Oncology Group Breast Cancer Screening Guidelines for Chest-Irradiated Hodgkin Lymphoma Survivors.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2023Article
- Radiation-Free Microwave Technology for Breast Lesion Detection Using Supervised Machine Learning Model.Tomography (Ann Arbor, Mich.) · 2023Article
- Circulating tumor biomarkers in early-stage breast cancer: characteristics, detection, and clinical developments.Frontiers in oncology · 2023Review
- A multicentric, single arm, prospective, stratified clinical investigation to evaluate MammoWave's ability in breast lesions detection.PloS one · 2023Article
- Evidence for objects of implementation in healthcare: considerations for Implementation Science and Implementation Science Communications.Implementation science : IS · 2022Article
- Using Real-World Data to Determine Health System Costs of Ontario Women Screened for Breast Cancer.Current oncology (Toronto, Ont.) · 2022Article
- The Early Detection of Breast Cancer Using Liquid Biopsies: Model Estimates of the Benefits, Harms, and Costs.Cancers · 2022Article
- Advances in breast cancer screening modalities and status of global screening programs.Chronic diseases and translational medicine · 2022Review
- Cost-effectiveness of using artificial intelligence versus polygenic risk score to guide breast cancer screening.BMC cancer · 2022Article
8 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors.
Natasha K StoutAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM). natasha_stout@hms.harvard.edu.
Sandra J LeeAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Clyde B SchechterAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Karla KerlikowskeAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Oguzhan AlagozAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Donald BerryAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Diana S M BuistAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Mucahit CevikAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Gary ChisholmAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Harry J de KoningAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Hui HuangAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Rebecca A HubbardAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Diana L MigliorettiAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Mark F MunsellAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Amy Trentham-DietzAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Nicolien T van RavesteynAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Anna N A TostesonAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Jeanne S MandelblattAffiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
Funding
Tumor Evolution and Metastasis ProgramP30CA016672 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI Kathrin Milbury · 1985 to 2026
$290.8MTranslational Engineering in Cancer (TEC)P30CA023108 · NCI · DARTMOUTH COLLEGE · PI Steven D Leach · 1985 to 2026
$91.3MStaff InvestigatorsP30CA093373 · NCI · UNIVERSITY OF CALIFORNIA DAVIS · PI PRIMO N. LARA · 2002 to 2026
$84.9MRisk-based Imaging Strategies to Improve Breast Cancer Surveillance OutcomesP01CA154292 · NCI · UNIVERSITY OF CALIFORNIA AT DAVIS · PI Diana L Miglioretti · 2011 to 2026
$52.9MStatistical Coordinating Center for the Breast Cancer Surveillance ConsortiumU01CA086076 · NCI · KAISER FOUNDATION HEALTH PLAN OF WASHINGTON · PI MIGLIORETTI, DIANA L · 2000 to 2011
$8.5MComparative Modeling: Informing Breast Cancer Control Practice & PolicyU01CA152958 · NCI · GEORGETOWN UNIVERSITY · PI BERRY, DONALD A, DE KONING, HARRY J · 2010 to 2015
$7.6MIMPROVING THE QUALITY OF MAMMOGRAPHIC INTERPRETATIONU01CA063731 · NCI · KAISER FOUNDATION HEALTH PLAN OF WASHINGTON · PI BUIST, DIANA SM · 1994 to 2011
$6.7MVERMONT BREAST CANCER SURVEILLANCE SYSTEMU01CA070013 · NCI · UNIVERSITY OF VERMONT &ST AGRIC COLLEGE · PI GELLER, BERTA M · 1995 to 2011
$6.7MUTILITY AND OUTCOMES FROM MAMMOGRAPHY IN NORTH CAROLINAU01CA070040 · NCI · UNIV OF NORTH CAROLINA CHAPEL HILL · PI YANKASKAS, BONNIE C · 1995 to 2011
$6.4MSan Francisco Mammography Registry-A Research SourceU01CA063740 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KERLIKOWSKE, KARLA M · 1994 to 2011
$6.2MSTRATEGIC STUDIES IN BREAST CANCER SURVEILLANCEU01CA086082 · NCI · DARTMOUTH COLLEGE · PI ONEGA, TRACY · 2000 to 2011
$4.9MREFERRAL PATTERNS AND COST ANALYSIS OF SCREENING MAMMOGRAPHY--FOLLOW-UP/BIOPSYU01CA063736 · NCI · COOPER INSTITUTE · PI CUTTER, GARY · 1994 to 2004
$2.7MNCI NIH HHS HHSN261201100031CNCI NIH HHS P01 CA154292NCI NIH HHS P01CA154292NCI NIH HHS P30 CA016672NCI NIH HHS P30 CA023108NCI NIH HHS P30 CA093373NCI NIH HHS U01 CA063731NCI NIH HHS U01 CA063736NCI NIH HHS U01 CA063740NCI NIH HHS U01 CA069976NCI NIH HHS U01 CA070013NCI NIH HHS U01 CA070040NCI NIH HHS U01 CA086076NCI NIH HHS U01 CA086082NCI NIH HHS U01 CA152958NCI NIH HHS U01CA152958NCI NIH HHS U01CA63731NCI NIH HHS U01CA63736NCI NIH HHS U01CA63740NCI NIH HHS U01CA69976NCI NIH HHS U01CA70013NCI NIH HHS U01CA70040NCI NIH HHS U01CA86076NCI NIH HHS U01CA86082NCI NIH HHS UC2 CA148577NCI NIH HHS UC2CA148577
Abstract
backgroundCompared with film, digital mammography has superior sensitivity but lower specificity for women aged 40 to 49 years and women with dense breasts. Digital has replaced film in virtually all US facilities, but overall population health and cost from use of this technology are unclear.
methodsUsing five independent models, we compared digital screening strategies starting at age 40 or 50 years applied annually, biennially, or based on density with biennial film screening from ages 50 to 74 years and with no screening. Common data elements included cancer incidence and test performance, both modified by breast density. Lifetime outcomes included mortality, quality-adjusted life-years, and screening and treatment costs.
resultsFor every 1000 women screened biennially from age 50 to 74 years, switching to digital from film yielded a median within-model improvement of 2 life-years, 0.27 additional deaths averted, 220 additional false-positive results, and $0.35 million more in costs. For an individual woman, this translates to a health gain of 0.73 days. Extending biennial digital screening to women ages 40 to 49 years was cost-effective, although results were sensitive to quality-of-life decrements related to screening and false positives. Targeting annual screening by density yielded similar outcomes to targeting by age. Annual screening approaches could increase costs to $5.26 million per 1000 women, in part because of higher numbers of screens and false positives, and were not efficient or cost-effective.
conclusionsThe transition to digital breast cancer screening in the United States increased total costs for small added health benefits. The value of digital mammography screening among women aged 40 to 49 years depends on women's preferences regarding false positives.
Indexed as
Direct Service CostsEarly Detection of CancerMammographyMass ScreeningAdultAgedBreast NeoplasmsCost-Benefit AnalysisFalse Positive ReactionsFemaleHumansMiddle AgedPredictive Value of TestsQuality-Adjusted Life YearsSensitivity and SpecificityTime Factors
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