Extending Age Ranges in Breast Cancer Screening in Four European Countries: Model Estimations of Harm-to-Benefit Ratios
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Model Overview
2.2. Analysis
2.3. Outcomes
- Overdiagnosed breast cancer cases/averted breast cancer deaths;
- False-positive results/averted breast cancer deaths;
- Overdiagnosed breast cancer cases/LYG;
- False-positive results/LYG.
2.4. Sensitivity Analysis
3. Results
3.1. Model Calibration and Validation
3.2. Outcomes of Different Screening Strategies
3.3. Sensitivity Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Examination Coverage by per Age Group 1 | Slovenia | Finland | Netherlands | Italy |
---|---|---|---|---|
45–49 | 54.3% 2 | 85.0% 2 | 75.5% 2 | 59.6% 2 |
50–54 | 54.3% | 85.0% | 75.5% | 59.6% |
55–59 | 65.0% | 85.9% | 76.2% | 63.2% |
60–64 | 52.4% | 86.8% | 76.3% | 63.9% |
65–69 | 48.8% | 73.0% | 75.7% | 61.5% |
70–74 | 48.8% 2 | 73.0% 2 | 70.1% | 61.5% 2 |
Stage-specific sensitivity of digital mammography DCIS | 0.726 | 0.596 3 | 0.865 4 | 0.821 |
Stage-specific sensitivity of digital mammography T1a | 0.785 | 0.811 | 0.553 3 | 1 4 |
Stage-specific sensitivity of digital mammography T1b | 0.656 | 0.761 4 | 0.481 3 | 0.717 |
Stage-specific sensitivity of digital mammography T1c | 0.780 3 | 0.946 4 | 0.857 | 0.814 |
Stage-specific sensitivity of digital mammography T2+ | 1 | 1 | 1 | 1 |
Referral rate by age 5 | ||||
<50 | 0.040 | 0.030 | 0.030 3 | 0.065 4 |
>50 | 0.034 | 0.028 | 0.023 3 | 0.058 4 |
Country | Strategy 1 | Number of Screening Tests | Harms | Benefits | Harm-to-Benefit Ratios | |||||
---|---|---|---|---|---|---|---|---|---|---|
Overdiagnosed BC Cases | False Positives | BC Deaths Averted | LY Gained | Overdiagnosed BC Cases/BC Deaths Averted | False Positives/BC Deaths Averted | Overdiagnosed BC Cases/LY Gained | False Positives/LY Gained | |||
Slovenia | 50–69 * | 9236 | 3.3 | 275.8 | 7.3 | 96.5 | 0.5 | 37.9 | 0.034 | 2.9 |
45–74 | 13,723 | +1.8 | +220.8 | +2.6 | +32.7 | 0.5 | 50.3 | 0.040 | 3.8 | |
45–69 | 11,696 | +0.1 | +150.2 | +0.8 | +18.2 | 0.4 | 53.0 | 0.030 | 3.7 | |
50–74 | 11,264 | +1.7 | +58.4 | +1.9 | +14.8 | 0.5 | 36.6 | 0.045 | 3.0 | |
Finland | 50–69 * | 9170 | 2.6 | 212.3 | 7.7 | 105.3 | 0.3 | 27.6 | 0.025 | 2.0 |
45–74 | 13,632 | +1.5 | +135.6 | +3.2 | +38.8 | 0.4 | 31.9 | 0.029 | 2.4 | |
45–69 | 12,034 | +0.4 | +96.7 | +1.4 | +24.2 | 0.3 | 34.2 | 0.023 | 2.4 | |
50–74 | 11,183 | +1.4 | +48.8 | +2.4 | +19.4 | 0.4 | 25.9 | 0.032 | 2.1 | |
Netherlands | 50–69 | 8948 | 3.2 | 150.1 | 13.0 | 185.6 | 0.2 | 11.6 | 0.017 | 0.8 |
45–74 | 13,288 | +1.9 | +172.5 | +4.2 | +59.5 | 0.3 | 18.8 | 0.021 | 1.3 | |
45–69 | 11,388 | +0.2 | +129.7 | +1.8 | +40 | 0.2 | 19.0 | 0.015 | 1.2 | |
50–74 * | 10,848 | +1.7 | +29.5 | +2.5 | +19.6 | 0.3 | 11.6 | 0.024 | 0.9 | |
Italy | 50–69 * | 9186 | 2.5 | 488.5 | 10.7 | 152.1 | 0.2 | 45.7 | 0.016 | 3.2 |
45–74 | 13,657 | +1.5 | +338.8 | +3.5 | +49.2 | 0.3 | 58.2 | 0.020 | 4.1 | |
45–69 | 11,641 | +0.1 | +219.1 | +1.4 | +32.0 | 0.2 | 58.7 | 0.014 | 3.8 | |
50–74 | 11,203 | +1.4 | +105.5 | +2.1 | +17.2 | 0.3 | 46.3 | 0.023 | 3.5 |
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Zielonke, N.; Geuzinge, A.; Heijnsdijk, E.A.M.; Heinävaara, S.; Senore, C.; Jarm, K.; de Koning, H.J.; van Ravesteyn, N.T.; on behalf of the EU-TOPIA Consortium. Extending Age Ranges in Breast Cancer Screening in Four European Countries: Model Estimations of Harm-to-Benefit Ratios. Cancers 2021, 13, 3360. https://doi.org/10.3390/cancers13133360
Zielonke N, Geuzinge A, Heijnsdijk EAM, Heinävaara S, Senore C, Jarm K, de Koning HJ, van Ravesteyn NT, on behalf of the EU-TOPIA Consortium. Extending Age Ranges in Breast Cancer Screening in Four European Countries: Model Estimations of Harm-to-Benefit Ratios. Cancers. 2021; 13(13):3360. https://doi.org/10.3390/cancers13133360
Chicago/Turabian StyleZielonke, Nadine, Amarens Geuzinge, Eveline A. M. Heijnsdijk, Sirpa Heinävaara, Carlo Senore, Katja Jarm, Harry J. de Koning, Nicolien T. van Ravesteyn, and on behalf of the EU-TOPIA Consortium. 2021. "Extending Age Ranges in Breast Cancer Screening in Four European Countries: Model Estimations of Harm-to-Benefit Ratios" Cancers 13, no. 13: 3360. https://doi.org/10.3390/cancers13133360