Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1997 Apr;51(2):180–186. doi: 10.1136/jech.51.2.180

Quantitative estimates of the impact of sensitivity and specificity in mammographic screening in Germany.

P G Warmerdam 1, H J de Koning 1, R Boer 1, P M Beemsterboer 1, M L Dierks 1, E Swart 1, B P Robra 1
PMCID: PMC1060442  PMID: 9196649

Abstract

STUDY OBJECTIVE: To estimate quantitatively the impact of the quality of mammographic screening (in terms of sensitivity and specificity) on the effects and costs of nationwide breast cancer screening. DESIGN: Three plausible "quality" scenarios for a biennial breast cancer screening programme for women aged 50-69 in Germany were analysed in terms of costs and effects using the Microsimulation Screening Analysis model on breast cancer screening and the natural history of breast cancer. Firstly, sensitivity and specificity in the expected situation (or "baseline" scenario) were estimated from a model based analysis of empirical data from 35,000 screening examinations in two German pilot projects. In the second "high quality" scenario, these properties were based on the more favourable diagnostic results from breast cancer screening projects and the nationwide programme in The Netherlands. Thirdly, a worst case, "low quality" hypothetical scenario with a 25% lower sensitivity than that experienced in The Netherlands was analysed. SETTING: The epidemiological and social situation in Germany in relation to mass screening for breast cancer. RESULTS: In the "baseline" scenario, an 11% reduction in breast cancer mortality was expected in the total German female population, ie 2100 breast cancer deaths would be prevented per year. It was estimated that the "high quality" scenario, based on Dutch experience, would lead to the prevention of an additional 200 deaths per year and would also cut the number of false positive biopsy results by half. The cost per life year gained varied from Deutsche mark (DM) 15,000 on the "high quality" scenario to DM 21,000 in the "low quality" setting. CONCLUSIONS: Up to 20% of the total costs of a screening programme can be spent on quality improvement in order to achieve a substantially higher reduction in mortality and reduce undesirable side effects while retaining the same cost effectiveness ratio as that estimated from the German data.

Full text

PDF
183

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beemsterboer P. M., de Koning H. J., Warmerdam P. G., Boer R., Swart E., Dierks M. L., Robra B. P. Prediction of the effects and costs of breast-cancer screening in Germany. Int J Cancer. 1994 Sep 1;58(5):623–628. doi: 10.1002/ijc.2910580502. [DOI] [PubMed] [Google Scholar]
  2. Boer R., Warmerdam P., de Koning H., van Oortmarssen G. Extra incidence caused by mammographic screening. Lancet. 1994 Apr 16;343(8903):979–979. doi: 10.1016/s0140-6736(94)90105-8. [DOI] [PubMed] [Google Scholar]
  3. Carter R., Glasziou P., van Oortmarssen G., de Koning H., Stevenson C., Salkeld G., Boer R. Cost-effectiveness of mammographic screening in Australia. Aust J Public Health. 1993 Mar;17(1):42–50. doi: 10.1111/j.1753-6405.1993.tb00103.x. [DOI] [PubMed] [Google Scholar]
  4. Chamberlain J., Moss S. M., Kirkpatrick A. E., Michell M., Johns L. National Health Service breast screening programme results for 1991-2. BMJ. 1993 Aug 7;307(6900):353–356. doi: 10.1136/bmj.307.6900.353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. De Koning H. J., Fracheboud J., Boer R., Verbeek A. L., Collette H. J., Hendriks J. H., van Ineveld B. M., de Bruyn A. E., van der Maas P. J. Nation-wide breast cancer screening in The Netherlands: support for breast-cancer mortality reduction. National Evaluation Team for Breast Cancer Screening (NETB). Int J Cancer. 1995 Mar 16;60(6):777–780. doi: 10.1002/ijc.2910600608. [DOI] [PubMed] [Google Scholar]
  6. Fletcher S. W., Black W., Harris R., Rimer B. K., Shapiro S. Report of the International Workshop on Screening for Breast Cancer. J Natl Cancer Inst. 1993 Oct 20;85(20):1644–1656. doi: 10.1093/jnci/85.20.1644. [DOI] [PubMed] [Google Scholar]
  7. Koopmanschap M. A., Lubbe K. T., van Oortmarssen G. J., van Agt H. M., van Ballegooijen M., Habbema J. K. Economic aspects of cervical cancer screening. Soc Sci Med. 1990;30(10):1081–1087. doi: 10.1016/0277-9536(90)90294-3. [DOI] [PubMed] [Google Scholar]
  8. Nyström L., Rutqvist L. E., Wall S., Lindgren A., Lindqvist M., Rydén S., Andersson I., Bjurstam N., Fagerberg G., Frisell J. Breast cancer screening with mammography: overview of Swedish randomised trials. Lancet. 1993 Apr 17;341(8851):973–978. doi: 10.1016/0140-6736(93)91067-v. [DOI] [PubMed] [Google Scholar]
  9. Paci E., Boer R., Zappa M., de Koning H. J., van Oortmarssen G. J., Crocetti E., Giorgi D., Rosselli del Turco M., Habbema J. D. A model-based prediction of the impact on reduction in mortality by a breast cancer screening programme in the city of Florence, Italy. Eur J Cancer. 1995;31A(3):348–353. doi: 10.1016/0959-8049(95)94001-f. [DOI] [PubMed] [Google Scholar]
  10. Paterok E. M., Rosenthal H., Richter S., Säbel M. Mammakarzinom: Trends von 1964 bis 1990. Ergebnisse einer Langzeitstudie. Rontgenpraxis. 1992 Oct;45(10):325–329. [PubMed] [Google Scholar]
  11. Robra B. P. Threat to German cancer-screening plan. Lancet. 1995 Jun 17;345(8964):1574–1574. doi: 10.1016/s0140-6736(95)91121-9. [DOI] [PubMed] [Google Scholar]
  12. de Koning H. J., Boer R., Warmerdam P. G., Beemsterboer P. M., van der Maas P. J. Quantitative interpretation of age-specific mortality reductions from the Swedish breast cancer-screening trials. J Natl Cancer Inst. 1995 Aug 16;87(16):1217–1223. doi: 10.1093/jnci/87.16.1217. [DOI] [PubMed] [Google Scholar]
  13. de Koning H. J., van Ineveld B. M., de Haes J. C., van Oortmarssen G. J., Klijn J. G., van der Maas P. J. Advanced breast cancer and its prevention by screening. Br J Cancer. 1992 Jun;65(6):950–955. doi: 10.1038/bjc.1992.199. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. de Koning H. J., van Ineveld B. M., van Oortmarssen G. J., de Haes J. C., Collette H. J., Hendriks J. H., van der Maas P. J. Breast cancer screening and cost-effectiveness; policy alternatives, quality of life considerations and the possible impact of uncertain factors. Int J Cancer. 1991 Oct 21;49(4):531–537. doi: 10.1002/ijc.2910490410. [DOI] [PubMed] [Google Scholar]
  15. van Ineveld B. M., van Oortmarssen G. J., de Koning H. J., Boer R., van der Maas P. J. How cost-effective is breast cancer screening in different EC countries? Eur J Cancer. 1993;29A(12):1663–1668. doi: 10.1016/0959-8049(93)90100-t. [DOI] [PubMed] [Google Scholar]
  16. van Oortmarssen G. J., Habbema J. D., van der Maas P. J., de Koning H. J., Collette H. J., Verbeek A. L., Geerts A. T., Lubbe K. T. A model for breast cancer screening. Cancer. 1990 Oct 1;66(7):1601–1612. doi: 10.1002/1097-0142(19901001)66:7<1601::aid-cncr2820660727>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES