gms | German Medical Science

67. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS), 13. Jahreskongress der Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V. (TMF)

21.08. - 25.08.2022, online

Age Limits of Mammography Screening in Germany – a Decision-Analytic Evaluation Based on Long-Term Benefits and Harms to Inform Decision Making

Meeting Abstract

  • Gaby Sroczynski - Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
  • Lára R. Hallsson - Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
  • Nikolai Mühlberger - Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
  • Felicitas Kühne - Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
  • Beate Jahn - Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
  • Heike Kölsch - Institute for Quality and Efficiency in Health Care (IQWiG), Köln, Germany
  • Stefan Sauerland - Institute for Quality and Efficiency in Health Care (IQWiG), Köln, Germany
  • Konstanze Angelescu - Institute for Quality and Efficiency in Health Care (IQWiG), Köln, Germany
  • Uwe Siebert - Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria; Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T. H. Chan School of Public Health, Boston, United States; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, United States

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. 67. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS), 13. Jahreskongress der Technologie- und Methodenplattform für die vernetzte medizinische Forschung e.V. (TMF). sine loco [digital], 21.-25.08.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocAbstr. 99

doi: 10.3205/22gmds097, urn:nbn:de:0183-22gmds0979

Veröffentlicht: 19. August 2022

© 2022 Sroczynski et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Introduction: In Germany, the current organized breast cancer (BC) screening program includes biennial mammography for women in the age of 50-69 years. The aim of this decision-analytic study was to systematically evaluate and compare the long-term benefits and harms of different mammography screening strategies including screening with earlier starting and/or stopping ages at different screening intervals.

Methods: A decision-analytic Markov state transition model simulating the development of BC including ductal carcinoma in situ (DCIS) was developed and validated for the German clinical and epidemiological context. We applied the model to evaluate various alternative screening strategies differing by age at initiation (age 45, 50 years) and end (age 69, 74, 79 years) of mammography screening and by screening interval (annual, biennial, triennial). German epidemiologic and clinical data as well as general quality of life (QoL) data were used as model input parameters, along with data from international studies on QoL related to cancer or screening, and mammography performance (sensitivity and specificity by age and breast density). Outcomes included lifetime risk of detected invasive BC, detected DCIS, death from detected invasive BC, life expectancy (in life years; LY), and quality-adjusted life years (QALY), number of mammograms, number of positive and false-positive mammograms, overdiagnosis, and the incremental harm-benefit ratio (IHBR). Uncertainty was assessed using comprehensive one-way and multi-way sensitivity analyses.

Results: Based on our decision-analytic model results, the highest gain in lifetime could be achieved with mammography screening at ages 45 to 79 (annual, age 45-49 years; biennial, 50-79 years) with on average 10.0 life years gained per 100 screening-adherent women (1.2 months per woman) compared with the current screening program (biennial, age 50-69 years). The highest gain in QALYs is expected by biennial mammography screening at ages 45 to 74 years with on average 3.5 QALYs gained per 100 women compared with the current screening program. Lowering the age of mammography screening initiation may yield a greater incremental benefit in terms of LYs and QALYs gained than extending the age limit for the end of mammography screening. Lowering the start age to 45 years (biennial, age 45-69 years) has an IHBR of 47 additional mammograms per LY gained compared with current screening. Compared to this early screening (biennial, age 45-69 years), additionally extending mammography screening to 74 years (biennial, age 45-74 years) results in 96 additional mammograms per LY gained. Annual screening at age 45-49 or extending biennial screening to age 79 results in substantially less favorable IHBRs. Overdiagnoses were mainly caused by DCIS. Key results were robust in sensitivity analyses.

Discussion/conclusion: Based on our decision-analysis, mammography screening at ages 45 to 49 years and at ages 70 to 79 years, in addition to the current mammography screening (biennial, age 50 to 69 years) may prevent additional deaths from breast cancer and increase remaining life expectancy. Considering quality of life and harm-benefit ratios, biennial screening from age 45 to 69 years and potentially up to 74 years may provide a good balance between additional benefits and harms.

This work was conducted and funded within a benefit assessment of the Institute for Quality and Efficiency in Health Care (IQWiG) commissioned by the Federal Joint Committee (G-BA). The funding agreement ensured the authors’ independence in designing the study, analyzing, and interpreting the data, writing, and publishing the report.

The authors declare that an ethics committee vote is not required.