The Cost-Effectiveness of Screening Mammography beyond Age 65 Years

A Systematic Review for the U.S. Preventive Services Task Force

  1. Jeanne Mandelblatt, MD, MPH;
  2. Somnath Saha, MD, MPH;
  3. Steven Teutsch, MD, MPH;
  4. Tom Hoerger, PhD;
  5. Albert L. Siu, MD, MSPH;
  6. David Atkins, MD, MPH;
  7. Jonathan Klein, MD;
  8. Mark Helfand, MD, MS; and
  9. for the Cost Work Group of the U.S. Preventive Services Task Force
  1. From Georgetown University Medical Center, Lombardi Cancer Center, Washington, DC; Oregon Health and Science University, Portland Veterans Affairs Medical Center, Portland, Oregon; Merck & Co., Inc., West Point, Pennsylvania; University of North Carolina, Research Triangle Institute, Research Triangle Park, North Carolina; Mount Sinai School of Medicine, New York, New York; Agency for Healthcare Research and Quality, Rockville, Maryland; and University of Rochester, Rochester, New York.

    Abstract

    Purpose: There are few data on the effects of disease biology and competing mortality on the effectiveness of screening women for breast cancer after age 65 years. The authors performed a review to determine the costs and benefits of mammography screening after age 65 years.

    Data Sources: Cost-effectiveness articles published between January 1989 and March 2002.

    Study Selection: Studies were identified by using MEDLINE and the National Health Service Economic Evaluation Database. The authors included research on screening after age 65 years conducted from a societal or government perspective; reviews and analyses of other technologies were excluded.

    Data Synthesis: 115 studies were identified and 10 met inclusion criteria. One study modeled age-dependent assumptions of disease biology. No study fully captured the potential harms of screening, including anxiety associated with false-positive results, overdiagnosis, and previous knowledge of cancer or living longer with the consequences of treatment. Studies differed in the specific strategies compared and in analytic approaches. On average, extending biennial screening to age 75 or 80 years was estimated to cost $34 000 to $88 000 (2002 U.S. dollars) per life-year gained, compared with stopping screening at age 65 years. Two studies suggested that it was more cost-effective to target healthy women than those with several competing risks for death.

    Conclusions: Current estimates suggest that biennial breast cancer screening after age 65 years reduces mortality at reasonable costs for women without clinically significant comorbid conditions. More data are needed on disease biology and preferences for benefits and harms in older women.

    Article and Author Information

    • Disclaimer: The authors are responsible for the contents of this review, including any clinical recommendations. No statement in this article should be construed as an official position from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, or National Cancer Institute.

    • Acknowledgments: The authors acknowledge the support and assistance of Kathryn Pyle Krages, AMLS, MA, of the Oregon Health and Science University Evidence-based Practice Center, and Trina McClendon for manuscript preparation.

    • Grant Support: By contracts 290-97-0018 and 290-97-0011 from the Agency for Healthcare Research and Quality and by grants #U01CA88283 and #KO5 CA96940 from the National Cancer Institute (Dr. Mandelblatt). Dr. Saha is supported by a research career development grant from the Health Services Research and Development Service of the Department of Veterans Affairs.

    • Potential Financial Conflicts of Interest: None disclosed.

    • Requests for Single Reprints: Jeanne Mandelblatt, MD, MPH, Lombardi Cancer Center, 2233 Wisconsin Avenue, Suite 317, Washington, DC 20007; e-mail, mandelbj{at}georgetown.edu.

    • Current Author Addresses: Dr. Mandelblatt: Lombardi Cancer Center, 2233 Wisconsin Avenue, Suite 317, Washington, DC 20007.

    • Dr. Saha: Portland Veterans Affairs Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239.

    • Dr. Teutsch: Merck & Co., PO Box 4, WP39-168, West Point, PA 19486-0004.

    • Dr. Hoerger: Research Triangle Institute, 3040 Cornwallis Road, Research Triangle Park, NC 27709.

    • Dr. Siu: Mount Sinai School of Medicine, 1 Gustave L. Levey Place, Box 1070, New York, NY 10029.

    • Dr. Atkins: Agency for Healthcare Research and Quality, 540 Gaither Road, 6th Floor, Rockville, MD 20850.

    • Dr. Klein: University of Rochester, 601 Elmwood, #69, Rochester, NY 14642.

    • Dr. Helfand: Portland Veterans Affairs Medical Center, 3181 SW Sam Jackson Park Road, Portland, OR 97201.

    Summary for Patients

    • Summaries for Patients:The Cost-Effectiveness of Mammography in Women Older than 65 Years of Age Ann Intern Med November 18, 2003 139:I-34
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    1. Ann Intern Med November 18, 2003 vol. 139 no. 10 835-842
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