ImportanceThe effects of breast cancer incidence changes and advances in screening and treatment on outcomes of different screening strategies are not well known.ObjectiveTo estimate outcomes of various mammography screening strategies.Design, Setting, and PopulationComparison of outcomes using 6 Cancer Intervention and Surveillance Modeling Network (CISNET) models and national data on breast cancer incidence, mammography performance, treatment effects, and other-cause mortality in US women without previous cancer diagnoses.ExposuresThirty-six screening strategies with varying start ages (40, 45, 50 years) and stop ages (74, 79 years) with digital mammography or digital breast tomosynthesis (DBT) annually, biennially, or a combination of intervals. Strategies were evaluated for all women and for Black women, assuming 100% screening adherence and “real-world” treatment.Main Outcomes and MeasuresEstimated lifetime benefits (breast cancer deaths averted, percent reduction in breast cancer mortality, life-years gained), harms (false-positive recalls, benign biopsies, overdiagnosis), and number of mammograms per 1000 women.ResultsBiennial screening with DBT starting at age 40, 45, or 50 years until age 74 years averted a median of 8.2, 7.5, or 6.7 breast cancer deaths per 1000 women screened, respectively, vs no screening. Biennial DBT screening at age 40 to 74 years (vs no screening) was associated with a 30.0% breast cancer mortality reduction, 1376 false-positive recalls, and 14 overdiagnosed cases per 1000 women screened. Digital mammography screening benefits were similar to those for DBT but had more false-positive recalls. Annual screening increased benefits but resulted in more false-positive recalls and overdiagnosed cases. Benefit-to-harm ratios of continuing screening until age 79 years were similar or superior to stopping at age 74. In all strategies, women with higher-than-average breast cancer risk, higher breast density, and lower comorbidity level experienced greater screening benefits than other groups. Annual screening of Black women from age 40 to 49 years with biennial screening thereafter reduced breast cancer mortality disparities while maintaining similar benefit-to-harm trade-offs as for all women.ConclusionsThis modeling analysis suggests that biennial mammography screening starting at age 40 years reduces breast cancer mortality and increases life-years gained per mammogram. More intensive screening for women with greater risk of breast cancer diagnosis or death can maintain similar benefit-to-harm trade-offs and reduce mortality disparities.

中文翻译：

---

比较不同乳腺癌筛查策略的协作建模

重要性乳腺癌发病率变化以及筛查和治疗进展对不同筛查策略结果的影响尚不清楚。目的评估各种乳房 X 光检查策略的结果。设计、设置和人群使用 6 个癌症干预和监测模型网络对结果进行比较（ CISNET）模型和国家数据，涉及以前没有癌症诊断的美国女性的乳腺癌发病率、乳房 X 光检查表现、治疗效果和其他原因死亡率。 暴露 36 种不同起始年龄（40、45、50 岁）和终止年龄的筛查策略（74、79 岁）每年、每两年或间隔时间组合进行数字乳房 X 线摄影或数字乳房断层合成 (DBT)。对所有女性和黑人女性的策略进行了评估，假设 100% 的筛查依从性和“真实世界”的治疗。 主要结果和措施 估计终生效益（避免乳腺癌死亡、乳腺癌死亡率降低百分比、增加的生命年）、危害（假阳性召回、良性活检、过度诊断）以及每 1000 名女性的乳房 X 光检查数量。结果从 40、45 或 50 岁开始直至 74 岁每两年进行 DBT 筛查，平均可避免 8.2、7.5 或 6.7 例乳腺癌分别是每 1000 名接受筛查的女性和未接受筛查的女性死亡人数。在 40 至 74 岁之间每两年进行一次 DBT 筛查（与不进行筛查相比）可将乳腺癌死亡率降低 30.0%，每 1000 名接受筛查的女性出现 1376 次假阳性召回，以及 14 例过度诊断病例。数字乳房 X 线摄影筛查的益处与 DBT 相似，但误报率更高。年度筛查增加了效益，但导致了更多的假阳性召回和过度诊断病例。持续筛查直至 79 岁的获益与危害比与 74 岁时停止筛查相似或优于。在所有策略中，乳腺癌风险高于平均水平、乳腺密度较高和合并症水平较低的女性获得了更大的筛查益处比其他群体。对 40 至 49 岁的黑人女性进行年度筛查，此后每两年进行一次筛查，可减少乳腺癌死亡率差异，同时保持与所有女性相似的利弊权衡。结论该模型分析表明，从 40 岁开始每两年进行一次乳房 X 光检查可减少乳腺癌死亡率差异。乳腺癌死亡率并增加每次乳房X光检查获得的生命年。对乳腺癌诊断或死亡风险较高的女性进行更深入的筛查可以保持类似的利弊权衡，并减少死亡率差异。