Abstract
The objective of this study is to describe how screen-preventable loss of life (screen-PLL) can be used to analyze the distribution of life savings with mammographic screening. The determination of screen-PLL with mammography is possible using a natural history model of breast cancer that simulates clinical and pathologic events of this disease. This investigation uses a Monte Carlo Markov model with data from the Surveillance, Epidemiology, and End Results Program; American Cancer Society; and National Vital Statistics System. Populations of one million women per screening strategy are simulated over a lifetime with mammographic screening based on current guidelines of the American Cancer Society (ACS), United States Preventive Services Task Force (USPSTF), triennial screening from age 50-70, and no screening. Screen-PLL curves are generated and show guideline performance over a lifetime. The screen-PLL curve with no screening is determined by tumor discovery through clinical awareness and has the highest values of screen-PLL. The ACS and USPSTF strategies demonstrate screen-PLL curves favoring the elderly. The curve for triennial screening is more uniform than the ACS or USPSTF curves but could be improved by adding screen(s) at either end of the 50-70 age range. This study introduces the use of screen-PLL as a tool to improve the understanding of screening guidelines and allowing a more balanced allocation of life savings across an aging population. The method presented shows how screen-PLL can be used to analyze and potentially improve breast cancer screening guidelines.
Highlights
The goal of screening is to detect early disease when treatment is more likely to be beneficial or lifesaving [1, 2]
This study introduces the use of screen-PLL as a tool to improve the understanding of screening guidelines and allowing a more balanced allocation of life savings across an aging population
The objective of this study is to describe a computer modeling approach to determine the screen-preventable life savings achievable within an aging population of women screened by the American Cancer Society (ACS) and United States Preventive Services Task Force (USPSTF) guidelines, as well as triennial screening and no screening
Summary
The goal of screening is to detect early disease when treatment is more likely to be beneficial or lifesaving [1, 2]. Mahoning Valley, https://foundation.mercy.com/ youngstown.aspx, The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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