A Mammography screening

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Two studies analyzed the impact of mammography screening of older women with an adjustment for comorbidity. The first study is a study by J. Mandelblatt and colleagues 19. The comorbidities introduced in the model were hypertension and CHF. Screening mammography was providing savings in life expectancy up to age 85, whatever the comorbidity level. Under the baseline assumptions, the benefits were ranging from 2.17 days for healthy 65-69 years old women to 0.69 day for a healthy 85 years old, and 0.49 day for an 85 years old woman with CHF. Although these numbers may look small, the benefit for women actually having breast cancer were 617 days for an average health 65-69 years old, and 178 days for an 85 years old. For women with CHF, the benefits were 311 and 126 days respectively. When the model was adjusted for quality of life, the benefits were about 0.5 days lower on the whole population, thus canceling the benefit for the oldest and sickest women. Importantly, the model was very sensitive to the baseline risk of breast cancer. Therefore a suggested strategy to improve the effectiveness and cost-effectiveness of mammography screening would be to validate predictive risk models such as the Gail model 20 beyond the age of 70-75 years and target the higher risk women.

Another decision analysis study attempted an approach of this type 21. The authors used bone density as a surrogate marker of estrogen levels and risk of breast cancer. They concluded that continuing mammography up to age 79 in women with the top 3 quartiles of bone mineral density would prevent 9.4 deaths/10,000, and add on average 2.1 days to life expectancy, at a marginal cost of $66,773. If mammography were used in all patients, it would prevent only 1.4 deaths/10,000, and add only 7.2 hours at a marginal cost-effectiveness of $117,689.

Recently the U.S. Preventive services task force conducted a systematic review of the cost-effectiveness of screening mammography after the age of 65 19. They concluded that extending a biennial screening mammography up to the age of 75-80 reduced mortality at reasonable

Potentially Curative Therapy

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