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Abstract
BACKGROUNDUS breast cancer mortality is declining, but thousands of women still die each year.METHODSTwo established simulation models examine 6 strategies that include increased screening and/or treatment or elimination of obesity versus continuation of current patterns. The models use common national data on incidence and obesity prevalence, competing causes of death, mammography characteristics, treatment effects, and survival/cure. Parameters are modified based on obesity (defined as BMI ≥ 30 kg/m2). Outcomes are presented for the year 2025 among women aged 25+ and include numbers of cases, deaths, mammograms and false-positives; age-adjusted incidence and mortality; breast cancer mortality reduction and deaths averted; and probability of dying of breast cancer.RESULTSIf current patterns continue, the models project that there would be about 50,100-57,400 (range across models) annual breast cancer deaths in 2025. If 90% of women were screened annually from ages 40 to 54 and biennially from ages 55 to 99 (or death), then 5100-6100 fewer deaths would occur versus current patterns, but incidence, mammograms, and false-positives would increase. If all women received the indicated systemic treatment (with no screening change), then 11,400-14,500 more deaths would be averted versus current patterns, but increased toxicity could occur. If 100% received screening plus indicated therapy, there would be 18,100-20,400 fewer deaths. Eliminating obesity yields 3300-5700 fewer breast cancer deaths versus continuation of current obesity levels.CONCLUSIONSMaximal reductions in breast cancer deaths could be achieved through optimizing treatment use, followed by increasing screening use and obesity prevention. Cancer 2013;119:2541–2548. © 2013 American Cancer Society.
Highlights
Breast cancer mortality continues to decrease in the United States, largely because of improved treatment and screening,[1] but it remains the most commonly diagnosed nonskin cancer and the second-leading female cause of cancer death, with about 40,000 dying each year.[2]
The models estimate the impact of applying 6 strategies in the US female population from 2012 to 2025 versus maintaining current patterns: 1) 90% of women screen annually from ages 40 to and biennially from ages to 99 and the remaining 10% do not screen at all; women receive treatment based on current patterns; 2) current screening, but 100% receive treatment indicated by age, stage, and ER/HER2 status18; 3) 90% screening and 100% receipt of indicated treatment; 4) 100% screening and current patterns of treatment; 5) 100% screening and 100% indicated treatment; and 6) eliminate obesity but maintain current screening and treatment
If screening continues at current levels, but all women receive indicated therapy, mortality rates could be decreased by 19.8%-27.5% versus continuation of current treatment patterns, and 11,400-14,500 deaths could be avoided (Table 2 and Fig. 2)
Summary
Breast cancer mortality continues to decrease in the United States, largely because of improved treatment and screening,[1] but it remains the most commonly diagnosed nonskin cancer and the second-leading female cause of cancer death, with about 40,000 dying each year.[2]. A list of the BCSC investigators and procedures for requesting data are provided at http://breastscreening.cancer.gov/. METHODS: Two established simulation models examine 6 strategies that include increased screening and/or treatment or elimination of obesity versus continuation of current patterns. If 90% of women were screened annually from ages 40 to and biennially from ages to 99 (or death), 5100-6100 fewer deaths would occur versus current patterns, but incidence, mammograms, and false-positives would increase. If all women received the indicated systemic treatment (with no screening change), 11,400-14,500 more deaths would be averted versus current patterns, but increased toxicity could occur. CONCLUSIONS: Maximal reductions in breast cancer deaths could be achieved through optimizing treatment use, followed by increasing screening use and obesity prevention.
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