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Clinical Benefits, Harms, and Cost-Effectiveness of Breast Cancer Screening for Survivors of Childhood Cancer Treated With Chest Radiation : A Comparative Modeling Study.

Publication ,  Journal Article
Yeh, JM; Lowry, KP; Schechter, CB; Diller, LR; Alagoz, O; Armstrong, GT; Hampton, JM; Leisenring, W; Liu, Q; Mandelblatt, JS; Miglioretti, DL ...
Published in: Ann Intern Med
September 1, 2020

BACKGROUND: Surveillance with annual mammography and breast magnetic resonance imaging (MRI) is recommended for female survivors of childhood cancer treated with chest radiation, yet benefits, harms, and costs are uncertain. OBJECTIVE: To compare the benefits, harms, and cost-effectiveness of breast cancer screening strategies in childhood cancer survivors. DESIGN: Collaborative simulation modeling using 2 Cancer Intervention and Surveillance Modeling Network breast cancer models. DATA SOURCES: Childhood Cancer Survivor Study and published data. TARGET POPULATION: Women aged 20 years with a history of chest radiotherapy. TIME HORIZON: Lifetime. PERSPECTIVE: Payer. INTERVENTION: Annual MRI with or without mammography, starting at age 25, 30, or 35 years. OUTCOME MEASURES: Breast cancer deaths averted, false-positive screening results, benign biopsy results, and incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS: Lifetime breast cancer mortality risk without screening was 10% to 11% across models. Compared with no screening, starting at age 25 years, annual mammography with MRI averted the most deaths (56% to 71%) and annual MRI (without mammography) averted 56% to 62%. Both strategies had the most screening tests, false-positive screening results, and benign biopsy results. For an ICER threshold of less than $100 000 per quality-adjusted life-year gained, screening beginning at age 30 years was preferred. RESULTS OF SENSITIVITY ANALYSIS: Assuming lower screening performance, the benefit of adding mammography to MRI increased in both models, although the conclusions about preferred starting age remained unchanged. LIMITATION: Elevated breast cancer risk was based on survivors diagnosed with childhood cancer between 1970 and 1986. CONCLUSION: Early initiation (at ages 25 to 30 years) of annual breast cancer screening with MRI, with or without mammography, might reduce breast cancer mortality by half or more in survivors of childhood cancer. PRIMARY FUNDING SOURCE: American Cancer Society and National Institutes of Health.

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Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

September 1, 2020

Volume

173

Issue

5

Start / End Page

331 / 341

Location

United States

Related Subject Headings

  • Young Adult
  • Radiography, Thoracic
  • Practice Guidelines as Topic
  • Models, Statistical
  • Mammography
  • Magnetic Resonance Imaging
  • Humans
  • General & Internal Medicine
  • Female
  • Early Detection of Cancer
 

Citation

APA
Chicago
ICMJE
MLA
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Yeh, J. M., Lowry, K. P., Schechter, C. B., Diller, L. R., Alagoz, O., Armstrong, G. T., … Stout, N. K. (2020). Clinical Benefits, Harms, and Cost-Effectiveness of Breast Cancer Screening for Survivors of Childhood Cancer Treated With Chest Radiation : A Comparative Modeling Study. Ann Intern Med, 173(5), 331–341. https://doi.org/10.7326/M19-3481
Yeh, Jennifer M., Kathryn P. Lowry, Clyde B. Schechter, Lisa R. Diller, Oguzhan Alagoz, Gregory T. Armstrong, John M. Hampton, et al. “Clinical Benefits, Harms, and Cost-Effectiveness of Breast Cancer Screening for Survivors of Childhood Cancer Treated With Chest Radiation : A Comparative Modeling Study.Ann Intern Med 173, no. 5 (September 1, 2020): 331–41. https://doi.org/10.7326/M19-3481.
Yeh JM, Lowry KP, Schechter CB, Diller LR, Alagoz O, Armstrong GT, et al. Clinical Benefits, Harms, and Cost-Effectiveness of Breast Cancer Screening for Survivors of Childhood Cancer Treated With Chest Radiation : A Comparative Modeling Study. Ann Intern Med. 2020 Sep 1;173(5):331–41.
Yeh, Jennifer M., et al. “Clinical Benefits, Harms, and Cost-Effectiveness of Breast Cancer Screening for Survivors of Childhood Cancer Treated With Chest Radiation : A Comparative Modeling Study.Ann Intern Med, vol. 173, no. 5, Sept. 2020, pp. 331–41. Pubmed, doi:10.7326/M19-3481.
Yeh JM, Lowry KP, Schechter CB, Diller LR, Alagoz O, Armstrong GT, Hampton JM, Leisenring W, Liu Q, Mandelblatt JS, Miglioretti DL, Moskowitz CS, Oeffinger KC, Trentham-Dietz A, Stout NK. Clinical Benefits, Harms, and Cost-Effectiveness of Breast Cancer Screening for Survivors of Childhood Cancer Treated With Chest Radiation : A Comparative Modeling Study. Ann Intern Med. 2020 Sep 1;173(5):331–341.

Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

September 1, 2020

Volume

173

Issue

5

Start / End Page

331 / 341

Location

United States

Related Subject Headings

  • Young Adult
  • Radiography, Thoracic
  • Practice Guidelines as Topic
  • Models, Statistical
  • Mammography
  • Magnetic Resonance Imaging
  • Humans
  • General & Internal Medicine
  • Female
  • Early Detection of Cancer