TY - JOUR
T1 - Personalizing age of cancer screening cessation based on comorbid conditions
T2 - Model estimates of harms and benefits
AU - Lansdorp-Vogelaar, Iris
AU - Gulati, Roman
AU - Mariotto, Angela B.
AU - Schechter, Clyde B.
AU - De Carvalho, Tiago M.
AU - Knudsen, Amy B.
AU - Van Ravesteyn, Nicolien T.
AU - Heijnsdijk, Eveline A.M.
AU - Pabiniak, Chester
AU - Van Ballegooijen, Marjolein
AU - Rutter, Carolyn M.
AU - Kuntz, Karen M.
AU - Feuer, Eric J.
AU - Etzioni, Ruth
AU - De Koning, Harry J.
AU - Zauber, Ann G.
AU - Mandelblatt, Jeanne S.
PY - 2014/7/15
Y1 - 2014/7/15
N2 - Background: Harms and benefits of cancer screening depend on age and comorbid conditions, but reliable estimates are lacking. Objective: To estimate the harms and benefits of cancer screening by age and comorbid conditions to inform decisions about screening cessation. Design: Collaborative modeling with 7 cancer simulation models and common data on average and comorbid condition level-specific life expectancy. Setting: U.S. population. Patients: U.S. cohorts aged 66 to 90 years in 2010 with average health or 1 of 4 comorbid condition levels: none, mild, moderate, or severe. Intervention: Mammography, prostate-specific antigen testing, or fecal immunochemical testing. Measurements: Lifetime cancer deaths prevented and life-years gained (benefits); false-positive test results and overdiagnosed cancer cases (harms). For each comorbid condition level, the age at which harms and benefits of screening were similar to that for persons with average health having screening at age 74 years. Results: Screening 1000 women with average life expectancy at age 74 years for breast cancer resulted in 79 to 96 (range across models) false-positive results, 0.5 to 0.8 overdiagnosed cancer cases, and 0.7 to 0.9 prevented cancer deaths. Although absolute numbers of harms and benefits differed across cancer sites, the ages at which to cease screening were consistent across models and cancer sites. For persons with no, mild, moderate, and severe comorbid conditions, screening until ages 76, 74, 72, and 66 years, respectively, resulted in harms and benefits similar to average-health persons. Limitation: Comorbid conditions influenced only life expectancy. Conclusion: Comorbid conditions are an important determinant of harms and benefits of screening. Estimates of screening benefits and harms by comorbid condition can inform discussions between providers and patients about personalizing screening cessation decisions.
AB - Background: Harms and benefits of cancer screening depend on age and comorbid conditions, but reliable estimates are lacking. Objective: To estimate the harms and benefits of cancer screening by age and comorbid conditions to inform decisions about screening cessation. Design: Collaborative modeling with 7 cancer simulation models and common data on average and comorbid condition level-specific life expectancy. Setting: U.S. population. Patients: U.S. cohorts aged 66 to 90 years in 2010 with average health or 1 of 4 comorbid condition levels: none, mild, moderate, or severe. Intervention: Mammography, prostate-specific antigen testing, or fecal immunochemical testing. Measurements: Lifetime cancer deaths prevented and life-years gained (benefits); false-positive test results and overdiagnosed cancer cases (harms). For each comorbid condition level, the age at which harms and benefits of screening were similar to that for persons with average health having screening at age 74 years. Results: Screening 1000 women with average life expectancy at age 74 years for breast cancer resulted in 79 to 96 (range across models) false-positive results, 0.5 to 0.8 overdiagnosed cancer cases, and 0.7 to 0.9 prevented cancer deaths. Although absolute numbers of harms and benefits differed across cancer sites, the ages at which to cease screening were consistent across models and cancer sites. For persons with no, mild, moderate, and severe comorbid conditions, screening until ages 76, 74, 72, and 66 years, respectively, resulted in harms and benefits similar to average-health persons. Limitation: Comorbid conditions influenced only life expectancy. Conclusion: Comorbid conditions are an important determinant of harms and benefits of screening. Estimates of screening benefits and harms by comorbid condition can inform discussions between providers and patients about personalizing screening cessation decisions.
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U2 - 10.7326/M13-2867
DO - 10.7326/M13-2867
M3 - Article
C2 - 25023249
AN - SCOPUS:84904396084
SN - 0003-4819
VL - 161
SP - 104
EP - 112
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 2
ER -
