Evidence map›Paper›PMID 34807717›Full record

ArticleAnnals of internal medicine2022

Cost-Effectiveness of Screening Mammography Beyond Age 75 Years : A Cost-Effectiveness Analysis.

John T Schousboe, Brian L Sprague, Linn Abraham, Ellen S O'Meara, Tracy Onega, Shailesh Advani, Louise M Henderson, Karen J Wernli, Dongyu Zhang, Diana L Miglioretti and 2 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of internal medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 3 pooled it
1.5field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 3 syntheses or guidelines pooled it, 28 citations in OpenAlex.

  1. Pooled it
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  7. Diagnostic yield of surveillance mammography among older women.Journal of the National Cancer Institute · 2026
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 8 institutions in 1 country.

John T SchousboePark Nicollet Clinic and HealthPartners Institute, HealthPartners, Bloomington, and Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota (J.T.S.).ORCID 0000-0002-9329-0750
Brian L SpragueDepartments of Surgery and Radiology, The University of Vermont, Burlington, Vermont (B.L.S.).
Linn AbrahamKaiser Permanente Washington Health Research Institute, Seattle, Washington (L.A., E.S.O., K.J.W.).ORCID 0000-0002-0840-1947
Ellen S O'MearaKaiser Permanente Washington Health Research Institute, Seattle, Washington (L.A., E.S.O., K.J.W.).
Tracy OnegaDepartment of Population Health Sciences and Huntsman Cancer Institute, The University of Utah, Salt Lake City, Utah (T.O.).ORCID 0000-0002-1633-3040
Shailesh AdvaniDepartment of Oncology, School of Medicine, Georgetown University, Washington, DC, and Terasaki Institute for Biomedical Innovation, Los Angeles, California (S.A.).
Louise M HendersonDepartment of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (L.M.H.).
Karen J WernliKaiser Permanente Washington Health Research Institute, Seattle, Washington (L.A., E.S.O., K.J.W.).ORCID 0000-0001-7945-0327
Dongyu ZhangCancer Control and Population Sciences Program and Department of Epidemiology, University of Florida, Gainesville, Florida (D.Z.).
Diana L MigliorettiDepartment of Public Health Sciences, University of California, Davis, California, and Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.L.M.).ORCID 0000-0002-5547-1833
Dejana BraithwaiteCancer Control and Population Sciences Program, Department of Epidemiology, and Institute on Aging, University of Florida, Gainesville, Florida (D.B.).
Karla KerlikowskeDepartments of Medicine and Epidemiology and Biostatistics and Department of Veterans Affairs (VA) Division of General Internal Medicine, University of California, San Francisco, San Francisco, California (K.K.).ORCID 0000-0001-8793-8779
Kaiser Permanente Washington Health Research Institute · USUniversity of Florida · USGeorgetown University · USSan Francisco VA Medical Center · USUniversity of Minnesota · USUniversity of North Carolina at Chapel Hill · USUniversity of Utah · USUniversity of Vermont · US

Funding

Staff InvestigatorsP30CA093373 · NCI · UNIVERSITY OF CALIFORNIA DAVIS · PI Gina M Dayton · 2002 to 2026
$84.9M
Risk-based Imaging Strategies to Improve Breast Cancer Surveillance OutcomesP01CA154292 · NCI · UNIVERSITY OF CALIFORNIA AT DAVIS · PI KARLA M KERLIKOWSKE · 2011 to 2026
$52.9M
Vermont Screening Process Documentation UnitU54CA163303 · NCI · UNIVERSITY OF VERMONT & ST AGRIC COLLEGE · PI SPRAGUE, BRIAN L · 2011 to 2017
$6.4M
Effectiveness of Pre-Operative MRI in Breast Cancer Surgery and OutcomesR01CA149365 · NCI · DARTMOUTH COLLEGE · PI ONEGA, TRACY · 2011 to 2015
$2.8M
COMORBIDITY AND SCREENING OUTCOMES AMONG OLDER WOMEN UNDERGOING MAMMOGRAPHYR01CA207361 · NCI · UNIVERSITY OF FLORIDA · PI BRAITHWAITE, DEJANA K · 2017 to 2020
$2.3M
Comparative effectiveness of breast imaging modalities: a natural experimentR01HS018366 · AHRQ · UNIVERSITY OF ILLINOIS AT CHICAGO · PI RAUSCHER, GARTH H · 2010 to 2014
$1.8M
AHRQ HHS R01 HS018366NCI NIH HHS P01 CA154292NCI NIH HHS P30 CA093373NCI NIH HHS R01 CA149365NCI NIH HHS R01 CA207361NCI NIH HHS U54 CA163303
6 · The paper itself

Abstract

backgroundThe cost-effectiveness of screening mammography beyond age 75 years remains unclear.

objectiveTo estimate benefits, harms, and cost-effectiveness of extending mammography to age 80, 85, or 90 years according to comorbidity burden.

designMarkov microsimulation model. DATA SOURCES: SEER (Surveillance, Epidemiology, and End Results) program and Breast Cancer Surveillance Consortium. TARGET POPULATION: U.S. women aged 65 to 90 years in groups defined by Charlson comorbidity score (CCS). TIME HORIZON: Lifetime. PERSPECTIVE: National health payer.

interventionScreening mammography to age 75, 80, 85, or 90 years. OUTCOME MEASURES: Breast cancer death, survival, and costs. RESULTS OF BASE-CASE ANALYSIS: 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. RESULTS OF SENSITIVITY ANALYSIS: Costs per QALY gained were sensitive to changes in invasive cancer incidence and shift of breast cancer stage with screening mammography. LIMITATION: No randomized controlled trials of screening mammography beyond age 75 years are available to provide model parameter inputs.

conclusionAlthough 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. Women considering screening beyond age 75 years should weigh the potential harms of overdiagnosis versus the potential benefit of averting death from breast cancer. PRIMARY FUNDING SOURCE: National Cancer Institute and National Institutes of Health.

Indexed as

Cost-Benefit AnalysisAgedAged, 80 and overAge FactorsBreast NeoplasmsComorbidityFemaleHumansMammographyMarkov ChainsMass ScreeningSEER ProgramUnited States

Identifiers

PMID34807717
PMCPMC9621600
OpenAlexW3215186241

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.