CONTEXT: Optimal ages of breast cancer screening cessation remain uncertain.
OBJECTIVE: To evaluate screening policies based on age and quartiles of life expectancy (LE).
DESIGN AND POPULATION: We used a stochastic model with proxies of age-dependent biology to evaluate the incremental U.S. societal costs and benefits
of biennial screening from age 50 until age 70, 79, or lifetime.
MAIN OUTCOME MEASURES: Discounted incremental costs per life years saved (LYS).
RESULTS: Lifetime screening is expensive (151,434 per LYS) if women have treatment and survival comparable to clinical trials (idealized); stopping at age 79 costs151,434 per LYS) if women have treatment and survival comparable to clinical trials (idealized);
stopping at age 79 costs 82,063 per LYS. This latter result corresponds to costs associated with an LE of 9.5 years at age
79, a value expected for 75% of 79-year-olds, about 50% of 80-year-olds, and 25% of 85-year-olds. Using actual treatment and
survival patterns, screening benefits are greater, and lifetime screening of all women might be considered ($114, 905 per
LYS), especially for women in the top 25% of LE for their age ($114, 905 per
LYS), especially for women in the top 25% of LE for their age (50,643 per LYS, life expectancy of ∼7 years at age 90).
CONCLUSIONS: If all women receive idealized treatment, the benefits of mammography beyond age 79 are too low relative to their costs to
justify continued screening. However, if treatment is not ideal, extending screening beyond age 79 could be considered, especially
for women in the top 25% of life expectancy for their age.
Key Words screening - cost-effectiveness - breast neoplasms - elderly
The authors have no conflicts of interest to report.
See editorial by Lantz and Ubel, p. 552
This work was supported by grants K05 CA96940 (JSM) and R01 CA72908 (JSM, KRY, CBS) and cooperative agreement U01-CA88293A
from the National Cancer Institute (JSM, JC, WL, CBS).