Abstract 1891
Background
Randomized clinical trials (RCTs) have shown that initiating breast cancer (BC) screening between ages 50 to 69 and continuing it for 10 years decreases BC mortality. None of the existing RCTs included women over 74 and all included few women aged 70-74, such that the 95% confidence interval (CI) ranged from preventing 32.1 deaths to causing 17.2 deaths. However, there is no RCT data on when a woman should stop receiving BC screening, yet an estimated 52% of women over 75 receive screening mammograms in the US. A future randomized trial to study when to stop screening may be infeasible and potentially unethical. We used insurance claims data to emulate a (hypothetical) target trial of the effect of continuing screening on BC mortality among Medicare beneficiaries aged 70-74 or 75-84 years.
Methods
We emulated a hypothetical trial using a population-based cohort study with 20% random sample of Medicare (1999-2008). We selected 1,058,013 Medicare beneficiaries aged 70 to 84 with a life expectancy of at least 10 years and no previous diagnosis of BC, and who received a BC screening. We compared the following two strategies: continuing annual screening vs. stopping screening mammograms. The main outcome was 8-year standardized risk of BC mortality by age group (70-74, 75-84). Estimates are standardized by baseline and time-varying variables.
Results
In the 70-74 age group, the estimated 8-year BC-specific death risk difference (95% CI) of continuing vs. stopping screening was -1.0 deaths per 1000 women (-2.3 to 0.1); hazard ratio 0.78 (0.63 to 0.95). In the 75-84 age group, the corresponding risk difference was 0.07 deaths per 1000 women (-0.93 to 1.3); hazard ratio 1.00 (0.83 to 1.19). The estimated 8-year risk of BC was 5.5% under the continue screening strategy (5.3% in the 70-74 age group, 5.8% in the 75-84 age group), and 3.9% under the stop screening strategy (3.9% in the 70-74 age group, 3.9% in the 75-84 age group).
Conclusions
Among women who have received at least one screening mammogram, we estimated that, compared with stopping BC screening, continuing screening past the age of 75 years results in no material difference in cancer-specific mortality over the following 8-year period. Our results in the age range of 70-74 match those of existing randomized clinical trials.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
US National Institutes of Health.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
4235 - First results of safety profile of nivolumab (NIVO) in combination with stereotactic body radiotherapy (SBRT) in II and III line of patients (pts) with metastatic renal cell carcinoma (mRCC) in NIVES Study
Presenter: Cristina Masini
Session: Poster Display session 3
Resources:
Abstract
2262 - Real world experience of Nivolumab therapy in Metastatic Renal Cancer patients: a 3 year multi-centre review
Presenter: Joanna Hack
Session: Poster Display session 3
Resources:
Abstract
4441 - “A pilot study of tremelimumab (treme) with or without cryoablation (cryo) in patients (pts) in metastatic renal cell carcinoma (mRCC).”
Presenter: Matthew Campbell
Session: Poster Display session 3
Resources:
Abstract
2613 - Lenvatinib (Len) alone or in combination with Everolimus (Eve) in heavily pretreated patients (pts) with metastatic renal cell carcinoma (mRCC) after immune checkpoint inhibitors (ICI) and VEGFR-targeted therapies: A single-institution experience
Presenter: Andrew Wiele
Session: Poster Display session 3
Resources:
Abstract
3249 - Weight loss is an underestimated adverse event with cabozantinib in patients with metastastic renal cell carcinoma (mRCC).
Presenter: Emeline Colomba
Session: Poster Display session 3
Resources:
Abstract
2405 - Impact of corticosteroids on nivolumab activity in metastatic clear cell renal cell carcinoma.
Presenter: Felix Lefort
Session: Poster Display session 3
Resources:
Abstract
4020 - Skeletal muscle loss as an adverse event during Cabozantinib treatment in patients with metastatic renal cell carcinoma
Presenter: Carolina Alves Costa Silva
Session: Poster Display session 3
Resources:
Abstract
2407 - Long term relative survival (RS) in patients with primary metastatic kidney cancer (primary mRCC): an analysis of 2,167 patients from the Austrian National Cancer Registry (ANCR).
Presenter: Monika Hackl
Session: Poster Display session 3
Resources:
Abstract
2470 - Advanced renal cell carcinoma: first results from the prospective research platform CARAT for patients with mRCC in Germany
Presenter: Peter Goebell
Session: Poster Display session 3
Resources:
Abstract
1533 - Are immune checkpoint inhibitors a valid option for papillary Renal Cell Carcinoma? Transcriptomic characterization of the immune infiltrate
Presenter: Manon De Vries-brilland
Session: Poster Display session 3
Resources:
Abstract