The controversy has continued largely because our current approach to screening assumes all women have the same risk for the same type of breast cancer.
Ledbetter's approach to spiritual screening assumes that the likely impact of the medical condition on the patient's life is a major factor [ 41].
The absolute difference in estimated breast cancer survival between the annual and biennial screening strategies were 0.6% at 5 years and 1.2% at 10 years, corresponding to a relative risk of 0.89 in favour of annual screening, assuming 100% compliance.
These estimates are then compared with the estimated number of deaths from breast cancer that could be prevented by mammographic screening assuming a 10 or 20% reduction in mortality, respectively, in women screened.
The use of a HPV test for the screening assuming a lower costs and higher sensitivity led to a higher CC reduction while the optimal mix would combine both screening and vaccination.
To model these conditions, we recalculated the impact of one of the scenarios for routine screening assuming that participation is suboptimal (less than 100%); this was done for the scenario with screening every six months, also referred to as semi-annual screening.
As an example, we calculated the impact of the above estimated extra costs per LyG on the CER of breast cancer screening, assuming that the mean age at breast cancer death (68 years (Netherlands Cancer Registry (NCR), 2005)) is the average age at which death is prevented by breast cancer screening in our population.
With respect to contact screening, assuming a TST specificity of 98% in BCG-unvaccinated cases, of 92% among infants and 60% among older BCG-vaccinated, screening of close contacts and casual contacts (when coming from low-incidence countries) with QFT or TST would result in savings compared to non-screening.
If VA-TP costs were used, the costs for screening with any of these tests would be substantially less than the cost of no screening, assuming either base case 10% false negative or DPP-false-negative costs, and GCT-pl would be the least expensive test (Table 2 and online appendix Figure A2).
For a 20% mortality reduction due to a decade of annual screening, assuming 100% future screening attendance reduced the net increase in breast cancer deaths from 0.86 to 0.62 per 1000 women screened starting at age 20 years, from 0.37 to 0.16 starting at age 30 years, and for starting at age 40 years this changed the net decrease from 0.46 to 0.64 per 1000 women screened.
