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Research ArticleSpecial Communications

Promoting Screening Mammography: Insight or Uptake?

John D. Keen
The Journal of the American Board of Family Medicine November 2010, 23 (6) 775-782; DOI: https://doi.org/10.3122/jabfm.2010.06.100065
John D. Keen
MD, MBA
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    Figure 1.

    Estimated breast cancer events per 1000 US women over 10 years at different starting ages, assuming 68% participation in screening mammography. *Data sources are listed in Tables 1 and 2. †At age 50, routine screening saves 1 in 1000 women over 10 years.

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    Figure 2.

    Estimated single-round screening mammography events and outcomes necessary to save one life by age group. Age-specific events and outcomes per screening round per cancer detected are Breast Cancer Surveillance Consortium data from Ref. 3. *The number needed to detect multiplier and overdiagnosis ratio are derived in Table 2.

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    Figure 3.

    A: Estimated single-round screening mammograms and follow-up diagnostic events necessary to save one life stratified by age. Age-specific events and outcomes per screening round per cancer detected are Breast Cancer Surveillance Consortium data from Ref. 3. B: Augmented view of estimated screening-induced biopsy outcomes necessary to save one life by age group. DCIS, ductal carcinoma in situ.

Tables

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    Table 1.

    Death and Diagnosis Risks Per 1000 Women in the United States over 10 Years

    Starting Age (Years)A (Smoker All-Cause Death Risk)*B (Nonsmoker All-Cause Death Risk)*C (Breast Cancer Diagnosis Risk)†D (DCIS)† (n [%])E (Breast Cancer Death Risk, No Screen)‡Ratios
    (C−D)/E (Breast Diagnosis to Death Risk)(A,B)/E (All to Breast Cancer Death Risk, Smoker/Nonsmoker)
    402719184 (21)2.5611/8
    506937306 (20)5.3513/7
    6016784428 (19)7.6522/11
    • * Data in columns A and B are from Ref. 36.

    • † Column C includes invasive cancer and ductal carcinoma in situ (DCIS) screen detected or not. Column D is DCIS only. Database from Surveillance, Epidemiology, and End Results Program 17 Incidence and Mortality 2000 to 2006.37

    • ‡ Data in column E is from Ref. 13, but uses 10 years instead of 15 and allows for modern therapy but no screening mammography.

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    Table 2.

    Estimated Breast Cancer Events Per 1000 Women in the United States over 10 Years

    Starting Age (Years)F (Lives Saved with Invite to Screening)*G (Screen-Detected Cancer)† (n [%])H (Pseudo-Disease)‡ (n [range])Ratios
    F/G (Life-Saving Proportion [%])G/F (Number Needed to Detect)H/F (Overdiagnosis) (n [range])H/G (Pseudo-Disease) (% [range])
    400.49 (50)4 (1–6)4.12511 (2–17)46 (10–68)
    500.8*17 (55)7 (1–10)4.8219 (2–13)42 (9–62)
    602.323 (56)10 (2–14)9.7104 (1–6)41 (9–61)
    • * Column F is the absolute risk reduction. The relative risk reductions from an invitation to screening mammography of 15% for women aged 40 to 59 and 30% for women aged 60 to 69 are from Ref. 3 and multiplied by column E, or screen-free absolute death risk. At age 50, routine screening saves 1 in 1000 women over 10 years.

    • † Column G assumes 74%, 81%, and 82% mammography sensitivity43 and 68% participation in screening from Ref. 3. The product is multiplied by column C.

    • ‡ Column H assumes an overdiagnosis baseline rate of 23%,26 with a range of 5%3 to 34%,27 which are multiplied by column C.

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The Journal of the American Board of Family Medicine: 23 (6)
The Journal of the American Board of Family Medicine
Vol. 23, Issue 6
November-December 2010
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Promoting Screening Mammography: Insight or Uptake?
John D. Keen
The Journal of the American Board of Family Medicine Nov 2010, 23 (6) 775-782; DOI: 10.3122/jabfm.2010.06.100065

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Promoting Screening Mammography: Insight or Uptake?
John D. Keen
The Journal of the American Board of Family Medicine Nov 2010, 23 (6) 775-782; DOI: 10.3122/jabfm.2010.06.100065
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