Model suggests extending annual mammography screening past age 75 may be cost-effective for some healthy older women

1. Model suggests extending annual mammography screening past age 75 may be cost-effective for some healthy older women, but risk for overdiagnosis may outweigh benefit

Abstract: https://www.acpjournals.org/doi/10.7326/M20-8076             

Editorial: https://www.acpjournals.org/doi/10.7326/M21-4235              

URL goes live when the embargo lifts

A modeling study found that very small number of deaths averted from breast cancer may be eclipsed by cost and potential harms of overdiagnosis when annual mammography screening is extended past age 75 years.  Biennial screening mammography to age 80 years is more cost-effective but the absolute number of deaths averted is small, especially for women with other underlying health conditions. The findings are published in Annals of Internal Medicine.

The U.S. Preventive Services Task Force recommends mammogram screening every other year for women through 74 years and the American Cancer Society recommends mammograms for women beyond age 74 if they have a life expectancy of 10 or more years. These recommendations differ because relatively few women older than 74 were included in randomized controlled trials designed to inform clinical guidelines.

Researchers for the National Cancer Institute and the National Institute of Health used data from SEER (Surveillance, Epidemiology, and End Results) program and Breast Cancer Surveillance Consortium to compare breast cancer death, survival, and cost with annual or biennial mammography screening from age 65 years to ages 75, 80, 85, and 90 across comorbidity levels. The researchers adapted a previously published Markov microsimulation model to assess the interventions in women 65 years or older without a previous diagnosis of ductal carcinoma in situ (DCIS) or invasive breast cancer. They found that mammogram screening every year after age 75 did not provide more benefit than harm with regard to a woman’s quality of life and the cost of care. But mammogram screening every other year from ages 75 to 80 did provide more benefit than harm; however, few deaths were avoided, especially for women with comorbid conditions. According to the study authors, women considering screening beyond age 75 years need to weigh the harms of overdiagnosis versus the potential benefit of averting death from breast cancer.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author, John T. Schousboe, MD, PhD, please email john.schousboe@parknicollet.com.

-------------------------------------------------

2. Patients with subsegmental pulmonary embolism at increased risk for recurrent venous thromboembolism 

Findings may be useful in guiding use of anticoagulant therapy in clinical practice

Abstract: https://www.acpjournals.org/doi/10.7326/M21-2981              

URL goes live when the embargo lifts

A multicenter prospective cohort study found that overall, patients with subsegmental pulmonary embolism who did not have proximal deep venous thrombosis had a higher-than-expected rate of recurrent venous thromboembolism. These findings may help guide use of anticoagulant therapy in clinical practice. The study is published in Annals of Internal Medicine.

The incidence of pulmonary embolism has been increasing, but its case-fatality rate is decreasing, suggesting overdiagnosis and a lesser severity of illness. Hence, the clinical significance of single or multiple isolated subsegmental pulmonary embolism (that is, no pulmonary embolism in segmental or more proximal vessels) remains unknown.

Researchers from The Ottawa Hospital and the University of Ottawa studied 266 patients at 18 sites over a 10-year period to determine the rate of recurrent venous thromboembolism in patients with subsegmental pulmonary embolism managed without anticoagulation. At diagnosis, patients underwent bilateral lower extremity venous ultrasonography, which was repeated 1 week later if results were negative. Patients without deep venous thrombosis did not receive anticoagulant therapy. At the 90-day follow-up, the incidence of recurrent venous thromboembolism was 2.1% and 5.7% in patients with single and multiple isolated subsegmental pulmonary embolism, respectively. No patients had a fatal recurrent pulmonary embolism. According to the researchers, these findings have implications for management of these patients with anticoagulation in clinical practice.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Marc Carrier, MD, MSc, please contact Jennifer Ganton at jganton@ohri.ca.

-------------------------------------------------

3. Analysis confirms newer ESC algorithms for ruling out heart attack more accurate than traditionally preferred diagnostic protocol

Abstract: https://www.acpjournals.org/doi/10.7326/M21-1499   

Editorial: https://www.acpjournals.org/doi/10.7326/M21-4342    

URL goes live when the embargo lifts

A meta-analysis confirms newer algorithms proposed by the European Society of Cardiology (ESC) for ruling out myocardial infarction are more accurate than the previously preferred diagnostic tool. These findings may help to triage patients seeking emergency care for suspected acute myocardial infarction, or heart attack. The results are published in Annals of Internal Medicine.

Chest pain is a common complaint for patients in emergency care settings, but only 10 to 20 percent of patients experience acute myocardial infarction. An inability to quickly rule out myocardial infarction leads to emergency care overcrowding and worse patient outcomes.

Researchers from National Taiwan University College of Medicine performed a comparative analysis between three algorithms recommended by the ESC. The 0/3-hour algorithm, which has traditionally served as the preferred diagnostic protocol, applies a cardiac troponin threshold at the 99th percentile of a normal reference population at presentation and 3 hours, in conjunction with clinical criteria, to rule out or rule in myocardial infarction. Recently, the ESC instead recommends the 0/1 or 0/2 algorithms, which applies assay-specific cardiac troponin thresholds lower than the 99th percentile of a normal reference population at presentation, combined with absolute changes within the first or second hour, to triage patients into rule-out, observation, and rule-in groups. Comparing 32 studies with 20 unique cohorts, the authors found that the 0/1, 0/2, and 0/3 algorithms had sensitivities of 99, 98.8, and 93.7 percent, respectively. Based on these sensitivities the authors concluded that, for the 120 out of 1,000 patients tested for myocardial infarction, only 3 would receive false-negative results using the 0/1 and 0/2 algorithms. Comparatively, up to fifteen patients would receive false-negative results using the 0/3 algorithm.

Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the lead author, Chien-Chang Lee, MD, ScD, please contact Jennie Hsu at piaonlyes@gmail.com.

-------------------------------------------------

New COVID-19 Content:

Neutralization of SARS-CoV-2 Variants in Transplant Recipients After Two and Three Doses of mRNA-1273 Vaccine

Deepali Kumar, MD; Victor H. Ferreira, PhD; Victoria G. Hall, MBBS; Queenie Hu, PhD; Reuben Samson, BSc; Terrance Ku, MSc; Matthew Ierullo, MSc; Beata Majchrzak-Kita, MSc; George Tomlinson, PhD; Anne-Claude Gingras, PhD; Atul Humar, MD

Brief Research Report

Full text: https://www.acpjournals.org/doi/10.7326/M21-3480

Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the lead author, Atul Humar, MD, MSc, please email atul.humar@uhn.ca.