Modeling Strategies to Optimize Cancer Screening in USPSTF Guideline-Noncompliant Women

Glen B. Taksler*, Elisabeth F.P. Peterse, Isarah Willems, Kevin Ten Haaf, Erik E.L. Jansen, Inge M.C.M. De Kok, Nicolien T. Van Ravesteyn, Harry J. De Koning, Iris Lansdorp-Vogelaar

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)


Importance: In 2018, only half of US women obtained all evidence-based cancer screenings. This proportion may have declined during the COVID-19 pandemic because of social distancing, high-risk factors, and fear.

Objective: To evaluate optimal screening strategies in women who obtain some, but not all, US Preventive Services Task Force (USPSTF)-recommended cancer screenings.

Design, Setting, and Participants: This modeling study was conducted from January 31, 2017, to July 20, 2020, and used 4 validated mathematical models from the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network using data from 20 million simulated women born in 1965 in the US.

Interventions: Forty-five screening strategies were modeled that combined breast, cervical, colorectal, and/or lung cancer (LC) screenings; restricted to 1, 2, 3 or 4 screenings per year; or all eligible screenings once every 5 years.

Main Outcomes and Measures: Modeled life-years gained from restricted cancer screenings as a fraction of those attainable from full compliance with USPSTF recommendations (maximum benefits). Results were stratified by LC screening eligibility (LC-eligible/ineligible). We repeated the analysis with 2018 adherence rates, evaluating the increase in adherence required for restricted screenings to have the same population benefit as USPSTF recommendations.

Results: This modeling study of 20 million simulated US women found that it was possible to reduce screening intensity to 1 carefully chosen test per year in women who were ineligible for LC screening and 2 tests per year in eligible women while maintaining 94% or more of the maximum benefits. Highly ranked strategies screened for various cancers, but less often than recommended by the USPSTF. For example, among LC-ineligible women who obtained just 1 screening per year, the optimal strategy frequently delayed breast and cervical cancer screenings by 1 year and skipped 3 mammograms entirely. Among LC-eligible women, LC screening was essential; strategies omitting it provided 25% or less of the maximum benefits. The top-ranked strategy restricted to 2 screenings per year was annual LC screening and alternating fecal immunochemical test with mammography (skipping mammograms when due for cervical cancer screening, 97% of maximum benefits). If adherence in a population of LC-eligible women obtaining 2 screenings per year were to increase by 1% to 2% (depending on the screening test), this model suggests that it would achieve the same benefit as USPSTF recommendations at 2018 adherence rates.

Conclusions and Relevance: This modeling study of 45 cancer screening strategies suggests that women who are noncompliant with cancer screening guidelines may be able to reduce USPSTF-recommended screening intensity with minimal reduction in overall benefits.

Original languageEnglish
Pages (from-to)885-894
Number of pages10
JournalJAMA Oncology
Issue number6
Early online date19 Apr 2021
Publication statusPublished - Jun 2021

Bibliographical note

Funding Information:
Funding/Support: Dr Taksler was supported by grants R01AG059979 from the National Institute on Aging and KL2TR000440 from the National Center for Advancing Translational Sciences and Clinical and Translational Science Collaborative of Cleveland. Drs Lansdorp-Vogelaar, Peterse, and Ms Willems were supported by grant U01CA199335 from the National Cancer Institute. Drs Ravesteyn and de Koning were supported by grant U01CA199218 (National Cancer Institute). Drs ten Haaf and de Koning were supported by grant U01CA199284 (National Cancer Institute). Mr Jansen and Dr de Kok were supported by grant U01CA199334 (National Cancer Institute).

Publisher Copyright:
© 2021 American Medical Association. All rights reserved.


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