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05.08.2019 | Original Research | Ausgabe 11/2019

Journal of General Internal Medicine 11/2019

Benefits and Harms of Mammography Screening for Women With Down Syndrome: a Collaborative Modeling Study

Zeitschrift:
Journal of General Internal Medicine > Ausgabe 11/2019
Autoren:
PhD Oguzhan Alagoz, MS Ali Hajjar, MS Sarocha Chootipongchaivat, PhD Nicolien T. van Ravesteyn, PhD Jennifer M. Yeh, PhD Mehmet Ali Ergun, MD, PhD Harry J. de Koning, MD Brian Chicoine, MD Barry Martin
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11606-019-05182-5) contains supplementary material, which is available to authorized users.
Ali Hajjar and Sarocha Chootipongchaivat are joint second authors.
Brian Chicoine and Barry Martin are joint senior authors
A preliminary version of this study was presented at the 2017 Down Syndrome Medical Interest Group-USA Annual Symposium in Sacramento, CA, between July 20 and 23, 2018.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

ABSTRACT

Background

Women with Down syndrome have a lower breast cancer risk and significantly lower life expectancies than women without Down syndrome. Therefore, it is not clear whether mammography screening strategies used for women without Down syndrome would benefit women with Down syndrome in the same way.

Objective

To determine the benefits and harms of various mammography screening strategies for women with Down syndrome using collaborative simulation modeling.

Design

Two established Cancer Intervention and Surveillance Modeling Network (CISNET) simulation models estimated the benefits and harms of various screening strategies for women with Down syndrome over a lifetime horizon.

Participants

We modeled a hypothetical cohort of US women with Down syndrome who were born in 1970.

Interventions

Annual, biennial, triennial, and one-time digital mammography screenings during the ages 40–74.

Main Measures

The models estimated numbers of mammograms, false-positives, benign biopsies, breast cancer deaths prevented, and life-years gained per 1000 screened women when compared with no screening.

Key Results

In average-risk women 50–74, biennial screening incurred 122 mammograms, 10 false-positive mammograms, and 1.4 benign biopsies per one life-year gained compared with no screening. In women with Down syndrome, the same screening strategy incurred 2752 mammograms, 242 false-positive mammograms, and 34 benign biopsies per one life-year gained compared with no screening. The harm/benefit ratio varied for other screening strategies, and was most favorable for one-time screening at age 50, which incurred 1629 mammograms, 144 false-positive mammograms, and 20 benign biopsies per one life-year gained compared with no screening.

Conclusions

The harm/benefit ratios for various mammography screening strategies in women with Down syndrome are not as favorable as those for average-risk women. The benefit of screening mammography for women with Down syndrome is less pronounced due to lower breast cancer risk and shorter life expectancy.

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