Outcomes of Breast Cancer Screening Strategies Based on Cancer Intervention and Surveillance Modeling Network Estimates

Published Online:https://doi.org/10.1148/radiol.232658

Cancer Intervention and Surveillance Modeling Network (CISNET) 2023 modeling estimates support annual breast cancer screening starting at 40 years of age.

Background

There is ongoing debate about recommendations for breast cancer screening strategies, specifically regarding the frequency of screening and the age at which to initiate screening.

Purpose

To compare estimates of breast cancer screening outcomes published by the Cancer Intervention and Surveillance Modeling Network (CISNET) to understand the benefits and risks of different screening scenarios.

Materials and Methods

Modeling estimates published by CISNET are based on hypothetical cohorts in the United States and compare women, starting at 40 years of age, who do and do not undergo breast cancer screening with mammography. The four scenarios assessed in this study, of multiple possible scenarios, were biennial screening ages 50–74 years (2009 and 2016 U.S. Preventive Services Task Force [USPSTF] recommendations), biennial screening ages 40–74 years (2023 USPSTF draft recommendation), annual screening ages 40–74 years, and annual screening ages 40–79 years. For each scenario, CISNET estimates of median lifetime benefits were compared. Risks that included false-positive screening results per examination and benign biopsies per examination were also calculated and compared.

Results

Estimates from CISNET 2023 showed that annual screening ages 40–79 years improved breast cancer mortality reduction compared with biennial screening ages 50–74 years and biennial screening ages 40–74 years (41.7%, 25.4%, and 30%, respectively). Annual screening ages 40–79 years averted the most breast cancer deaths (11.5 per 1000) and gained the most life-years (230 per 1000) compared with other screening scenarios (range, 6.7–11.5 per 1000 and 121–230 per 1000, respectively). False-positive screening results per examination were less than 10% for all screening scenarios (range, 6.5%–9.6%) and lowest for annual screening ages 40–79 years (6.5%). Benign biopsies per examination were less than 1.33% for all screening scenarios (range, 0.88%–1.32%) and lowest for annual screening ages 40–79 years (0.88%).

Conclusion

CISNET 2023 modeling estimates indicate that annual breast cancer screening starting at 40 years of age provides the greatest benefit to women and the least risk per examination.

© RSNA, 2024

See also the editorial by Joe in this issue.

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Article History

Received: Oct 1 2023
Revision requested: Oct 24 2023
Revision received: Dec 27 2023
Accepted: Jan 4 2024
Published online: Feb 20 2024