Evaluation of health benefits and harms of the breast cancer screening programme in the Basque Country using discrete event simulation

Arrospide, Arantzazu; Rue, Montserrat; Van Ravesteyn, Nicolien T.; Comas Serrano, Mercè; Larrañaga, Nerea; Sarriugarte, Garbiñe; Mar, Javier

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Evaluation of health benefits and harms of the breast cancer screening programme in the Basque Country using discrete event simulation

Tipus de document: Article

Versió del document: Versió publicada

Data de publicació: 2015

Aquest document està subjecte a una llicència Creative Commons

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Citació: Arrospide A, Rue M, van Ravesteyn NT, Comas M, Larrañaga N, Sarriugarte G. et al. Evaluation of health benefits and harms of the breast cancer screening programme in the Basque Country using discrete event simulation. BMC Cancer. 2015 Oct 12;15:671. doi: 10.1186/s12885-015-1700-4.

Enllaç permanent: http://hdl.handle.net/10230/25761

Resum:

BACKGROUND: Since the breast cancer screening programme in the Basque Country (BCSPBC) was started in 1996, more than 400,000 women aged 50 to 69 years have been invited to participate. Based on epidemiological observations and simulation techniques it is possible to extend observed short term data into anticipated long term results. The aim of this study was to assess the effectiveness of the programme through 2011 by quantifying the outcomes in breast cancer mortality, life-years gained, false positive results, and overdiagnosis. METHODS: A discrete event simulation model was constructed to reproduce the natural history of breast cancer (disease-free, pre-clinical, symptomatic, and disease-specific death) and the actual observed characteristics of the screening programme during the evaluated period in the Basque women population. Goodness-of-fit statistics were applied for model validation. The screening effects were measured as differences in benefits and harms between the screened and unscreened populations. Breast cancer mortality reduction and life-years gained were considered as screening benefits, whereas, overdiagnosis and false positive results were assessed as harms. Results for a single cohort were also obtained. RESULTS: The screening programme yielded a 16 % reduction in breast cancer mortality and a 10 % increase in the incidence of breast cancer through 2011. Almost 2 % of all the women in the programme had a false positive result during the evaluation period. When a single cohort was analysed, the number of deaths decreased by 13 %, and 4 % of screen-detected cancers were overdiagnosed. Each woman with BC detected by the screening programme gained 2.5 life years due to early detection corrected by lead time. CONCLUSIONS: Fifteen years after the screening programme started, this study supports an important decrease in breast cancer mortality due to the screening programme, with reasonable risk of overdiagnosis and false positive results, and sustains the continuation of the breast cancer screening programme in the Basque population.