Extending age ranges in breast cancer screening in four european countries: Model estimations of harm-to-benefit ratios

EU-TOPIA Consortium

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The main benefit of breast cancer (BC) screening is a reduction in mortality from BC. However, screening also causes harms such as overdiagnosis and false-positive results. The balance between benefits and harms varies by age. This study aims to assess how harm-to-benefit ratios of BC screening vary by age in the Netherlands, Finland, Italy and Slovenia. Using microsimulation models, we simulated biennial screening with 100% attendance at varying ages for cohorts of women followed over a lifetime. The number of overdiagnoses, false-positive diagnoses, BC deaths averted and life-years gained (LYG) were calculated per 1000 women. We compared four strategies (50–69, 45–69, 45–74 and 50–74) by calculating four harm-to-benefit ratios, respectively. Screening women at 45–74 or 50–74 years would be less beneficial in any of the four countries than screening women at 45–69, which would result in relatively fewer overdiagnoses per death averted or LYG compared to the reference strategy of 50–69. At the same time, false-positive results per death averted would increase substantially. Adapting the age range of BC screening is an option to improve harm-to-benefit ratios in all four countries. Prioritization of considered harms and benefits affects the interpretation of results.

Original languageEnglish
Article number3360
Issue number13
Publication statusPublished - 4 Jul 2021

Bibliographical note

Funding Information:
Funding: This modelling study is part of the EU-TOPIA project, funded by the EU-Framework Programme (Horizon 2020) of the European Commission, project reference 634753. The authors alone are responsible for the views expressed in this manuscript.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


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