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Coldman A.J.,BC Cancer Agency and | Phillips N.,BC Cancer Agency and
British Journal of Cancer | Year: 2014

Background:Cancers not detected by breast screening are commonly assumed to have poorer prognosis.Methods:We examined the survival experience of all women aged 50-74 years diagnosed with a first breast cancer between 1998 and 2006 in British Columbia, Canada and determined their screening experience. Disease-specific survival rates were calculated and, for cases diagnosed in 2002, prognostic factors (size, nodal involvement, grade ER status and stage) were examined by time since screening.Results:Breast cancers diagnosed at screening had the best survival (P<0.001). Cancers detected within 12 months of a negative screen had similar survival rates (P=0.98) to those diagnosed within 12-23 and 24-47 months, with other non-screen-detected cancers having poorer survival (P<0.001). The prognostic profile of cancers diagnosed in 2002 followed a similar pattern.Interpretation:There was no evidence that cancers diagnosed within 12 months had poorer prognosis than those diagnosed up to 48 months following screening. © 2014 Cancer Research UK.


Pataky R.,BC Cancer Agency | Phillips N.,BC Cancer Agency and | Peacock S.,BC Cancer Agency | Peacock S.,University of British Columbia | Coldman A.J.,BC Cancer Agency and
Journal of Cancer Policy | Year: 2014

There is little cost-effectiveness evidence for breast cancer screening with mammography in women under the age of 50 years, or over the age of 70 years, and available estimates vary widely. The Canadian Task Force on Preventive Health Care (CTFPHC) took cost-effectiveness into account in their recent recommendations on breast cancer screening, but no data are available from a Canadian setting. We constructed a microsimulation model using data from the Screening Mammography Program of British Columbia (BC) and the BC Cancer Registry. Eight screening strategies with varying age ranges and frequencies were compared to a reference strategy of no screening. Local screening, diagnostic, and treatment costs, and utility weights from the literature were applied to health states. Cost-effectiveness was expressed as incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves, using the results of probabilistic sensitivity analysis. The most cost-effective strategies were biennial screening from ages 50 to 69, with an ICER of $28,921/QALY, and biennial screening from 40 to 69, with an ICER of $86,029/QALY. Screening women ages 40-49 was more cost-effective than screening women ages 70-74, which conflicts with the recommendations of the CTFPHC. There was, however, considerable uncertainty around these cost-effectiveness results. Regardless of willingness-to-pay, no single strategy was significantly more likely to be cost effective than the others. There is value in reducing the uncertainty around these cost-effectiveness estimates, to better inform future screening policy. © 2014 The Authors.Published by Elsevier Ltd.

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