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Which strategies reduce breast cancer mortality most?
Author(s) -
Mandelblatt Jeanne,
van Ravesteyn Nicolien,
Schechter Clyde,
Chang Yaojen,
Huang AnTsun,
Near Aimee M.,
de Koning Harry,
Jemal Ahmedin
Publication year - 2013
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28087
Subject(s) - medicine , breast cancer , incidence (geometry) , demography , obesity , cancer , mammography , cause of death , disease , physics , sociology , optics
BACKGROUND US breast cancer mortality is declining, but thousands of women still die each year. METHODS Two 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/m 2 ). 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. RESULTS If 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. CONCLUSIONS Maximal 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 .