Personalizing age of cancer screening cessation based on comorbid conditions

Model estimates of harms and benefits

Iris Lansdorp-Vogelaar, Roman Gulati, Angela B. Mariotto, Clyde B. Schechter, Tiago M. De Carvalho, Amy B. Knudsen, Nicolien T. Van Ravesteyn, Eveline A M Heijnsdijk, Chester Pabiniak, Marjolein Van Ballegooijen, Carolyn M. Rutter, Karen M. Kuntz, Eric J. Feuer, Ruth Etzioni, Harry J. De Koning, Ann G. Zauber, Jeanne S. Mandelblatt

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background: Harms and benefits of cancer screening depend on age and comorbid conditions, but reliable estimates are lacking. Objective: To estimate the harms and benefits of cancer screening by age and comorbid conditions to inform decisions about screening cessation. Design: Collaborative modeling with 7 cancer simulation models and common data on average and comorbid condition level-specific life expectancy. Setting: U.S. population. Patients: U.S. cohorts aged 66 to 90 years in 2010 with average health or 1 of 4 comorbid condition levels: none, mild, moderate, or severe. Intervention: Mammography, prostate-specific antigen testing, or fecal immunochemical testing. Measurements: Lifetime cancer deaths prevented and life-years gained (benefits); false-positive test results and overdiagnosed cancer cases (harms). For each comorbid condition level, the age at which harms and benefits of screening were similar to that for persons with average health having screening at age 74 years. Results: Screening 1000 women with average life expectancy at age 74 years for breast cancer resulted in 79 to 96 (range across models) false-positive results, 0.5 to 0.8 overdiagnosed cancer cases, and 0.7 to 0.9 prevented cancer deaths. Although absolute numbers of harms and benefits differed across cancer sites, the ages at which to cease screening were consistent across models and cancer sites. For persons with no, mild, moderate, and severe comorbid conditions, screening until ages 76, 74, 72, and 66 years, respectively, resulted in harms and benefits similar to average-health persons. Limitation: Comorbid conditions influenced only life expectancy. Conclusion: Comorbid conditions are an important determinant of harms and benefits of screening. Estimates of screening benefits and harms by comorbid condition can inform discussions between providers and patients about personalizing screening cessation decisions.

Original languageEnglish (US)
Pages (from-to)104-112
Number of pages9
JournalAnnals of internal medicine
Volume161
Issue number2
DOIs
StatePublished - Jul 15 2014
Externally publishedYes

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Early Detection of Cancer
Life Expectancy
Neoplasms
Health
Mammography
Prostate-Specific Antigen
Breast Neoplasms
Population

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Lansdorp-Vogelaar, I., Gulati, R., Mariotto, A. B., Schechter, C. B., De Carvalho, T. M., Knudsen, A. B., ... Mandelblatt, J. S. (2014). Personalizing age of cancer screening cessation based on comorbid conditions: Model estimates of harms and benefits. Annals of internal medicine, 161(2), 104-112. https://doi.org/10.7326/M13-2867

Personalizing age of cancer screening cessation based on comorbid conditions : Model estimates of harms and benefits. / Lansdorp-Vogelaar, Iris; Gulati, Roman; Mariotto, Angela B.; Schechter, Clyde B.; De Carvalho, Tiago M.; Knudsen, Amy B.; Van Ravesteyn, Nicolien T.; Heijnsdijk, Eveline A M; Pabiniak, Chester; Van Ballegooijen, Marjolein; Rutter, Carolyn M.; Kuntz, Karen M.; Feuer, Eric J.; Etzioni, Ruth; De Koning, Harry J.; Zauber, Ann G.; Mandelblatt, Jeanne S.

In: Annals of internal medicine, Vol. 161, No. 2, 15.07.2014, p. 104-112.

Research output: Contribution to journalArticle

Lansdorp-Vogelaar, I, Gulati, R, Mariotto, AB, Schechter, CB, De Carvalho, TM, Knudsen, AB, Van Ravesteyn, NT, Heijnsdijk, EAM, Pabiniak, C, Van Ballegooijen, M, Rutter, CM, Kuntz, KM, Feuer, EJ, Etzioni, R, De Koning, HJ, Zauber, AG & Mandelblatt, JS 2014, 'Personalizing age of cancer screening cessation based on comorbid conditions: Model estimates of harms and benefits', Annals of internal medicine, vol. 161, no. 2, pp. 104-112. https://doi.org/10.7326/M13-2867
Lansdorp-Vogelaar I, Gulati R, Mariotto AB, Schechter CB, De Carvalho TM, Knudsen AB et al. Personalizing age of cancer screening cessation based on comorbid conditions: Model estimates of harms and benefits. Annals of internal medicine. 2014 Jul 15;161(2):104-112. https://doi.org/10.7326/M13-2867
Lansdorp-Vogelaar, Iris ; Gulati, Roman ; Mariotto, Angela B. ; Schechter, Clyde B. ; De Carvalho, Tiago M. ; Knudsen, Amy B. ; Van Ravesteyn, Nicolien T. ; Heijnsdijk, Eveline A M ; Pabiniak, Chester ; Van Ballegooijen, Marjolein ; Rutter, Carolyn M. ; Kuntz, Karen M. ; Feuer, Eric J. ; Etzioni, Ruth ; De Koning, Harry J. ; Zauber, Ann G. ; Mandelblatt, Jeanne S. / Personalizing age of cancer screening cessation based on comorbid conditions : Model estimates of harms and benefits. In: Annals of internal medicine. 2014 ; Vol. 161, No. 2. pp. 104-112.
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abstract = "Background: Harms and benefits of cancer screening depend on age and comorbid conditions, but reliable estimates are lacking. Objective: To estimate the harms and benefits of cancer screening by age and comorbid conditions to inform decisions about screening cessation. Design: Collaborative modeling with 7 cancer simulation models and common data on average and comorbid condition level-specific life expectancy. Setting: U.S. population. Patients: U.S. cohorts aged 66 to 90 years in 2010 with average health or 1 of 4 comorbid condition levels: none, mild, moderate, or severe. Intervention: Mammography, prostate-specific antigen testing, or fecal immunochemical testing. Measurements: Lifetime cancer deaths prevented and life-years gained (benefits); false-positive test results and overdiagnosed cancer cases (harms). For each comorbid condition level, the age at which harms and benefits of screening were similar to that for persons with average health having screening at age 74 years. Results: Screening 1000 women with average life expectancy at age 74 years for breast cancer resulted in 79 to 96 (range across models) false-positive results, 0.5 to 0.8 overdiagnosed cancer cases, and 0.7 to 0.9 prevented cancer deaths. Although absolute numbers of harms and benefits differed across cancer sites, the ages at which to cease screening were consistent across models and cancer sites. For persons with no, mild, moderate, and severe comorbid conditions, screening until ages 76, 74, 72, and 66 years, respectively, resulted in harms and benefits similar to average-health persons. Limitation: Comorbid conditions influenced only life expectancy. Conclusion: Comorbid conditions are an important determinant of harms and benefits of screening. Estimates of screening benefits and harms by comorbid condition can inform discussions between providers and patients about personalizing screening cessation decisions.",
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AU - Lansdorp-Vogelaar, Iris

AU - Gulati, Roman

AU - Mariotto, Angela B.

AU - Schechter, Clyde B.

AU - De Carvalho, Tiago M.

AU - Knudsen, Amy B.

AU - Van Ravesteyn, Nicolien T.

AU - Heijnsdijk, Eveline A M

AU - Pabiniak, Chester

AU - Van Ballegooijen, Marjolein

AU - Rutter, Carolyn M.

AU - Kuntz, Karen M.

AU - Feuer, Eric J.

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AU - De Koning, Harry J.

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AU - Mandelblatt, Jeanne S.

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N2 - Background: Harms and benefits of cancer screening depend on age and comorbid conditions, but reliable estimates are lacking. Objective: To estimate the harms and benefits of cancer screening by age and comorbid conditions to inform decisions about screening cessation. Design: Collaborative modeling with 7 cancer simulation models and common data on average and comorbid condition level-specific life expectancy. Setting: U.S. population. Patients: U.S. cohorts aged 66 to 90 years in 2010 with average health or 1 of 4 comorbid condition levels: none, mild, moderate, or severe. Intervention: Mammography, prostate-specific antigen testing, or fecal immunochemical testing. Measurements: Lifetime cancer deaths prevented and life-years gained (benefits); false-positive test results and overdiagnosed cancer cases (harms). For each comorbid condition level, the age at which harms and benefits of screening were similar to that for persons with average health having screening at age 74 years. Results: Screening 1000 women with average life expectancy at age 74 years for breast cancer resulted in 79 to 96 (range across models) false-positive results, 0.5 to 0.8 overdiagnosed cancer cases, and 0.7 to 0.9 prevented cancer deaths. Although absolute numbers of harms and benefits differed across cancer sites, the ages at which to cease screening were consistent across models and cancer sites. For persons with no, mild, moderate, and severe comorbid conditions, screening until ages 76, 74, 72, and 66 years, respectively, resulted in harms and benefits similar to average-health persons. Limitation: Comorbid conditions influenced only life expectancy. Conclusion: Comorbid conditions are an important determinant of harms and benefits of screening. Estimates of screening benefits and harms by comorbid condition can inform discussions between providers and patients about personalizing screening cessation decisions.

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