Comparing CISNET Breast Cancer Incidence and Mortality Predictions to Observed Clinical Trial Results of Mammography Screening from Ages 40 to 49

Jeroen J. van den Broek*, Nicolien T. van Ravesteyn, Jeanne S. Mandelblatt, Hui Huang, Mehmet Ali Ergun, Elizabeth S. Burnside, Cong Xu, Yisheng Li, Oguzhan Alagoz, Sandra J. Lee, Natasha K. Stout, Juhee Song, Amy Trentham-Dietz, Sylvia K. Plevritis, Sue M. Moss, Harry J. de Koning

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)


Background. The UK Age trial compared annual mammography screening of women ages 40 to 49 years with no screening and found a statistically significant breast cancer mortality reduction at the 10-year follow-up but not at the 17-year follow-up. The objective of this study was to compare the observed Age trial results with the Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer model predicted results. Methods. Five established CISNET breast cancer models used data on population demographics, screening attendance, and mammography performance from the Age trial together with extant natural history parameters to project breast cancer incidence and mortality in the control and intervention arm of the trial. Results. The models closely reproduced the effect of annual screening from ages 40 to 49 years on breast cancer incidence. Restricted to breast cancer deaths originating from cancers diagnosed during the intervention phase, the models estimated an average 15% (range across models, 13% to 17%) breast cancer mortality reduction at the 10-year follow-up compared with 25% (95% CI, 3% to 42%) observed in the trial. At the 17-year follow-up, the models predicted 13% (range, 10% to 17%) reduction in breast cancer mortality compared with the non-significant 12% (95% CI, -4% to 26%) in the trial. Conclusions. The models underestimated the effect of screening on breast cancer mortality at the 10-year follow-up. Overall, the models captured the observed long-term effect of screening from age 40 to 49 years on breast cancer incidence and mortality in the UK Age trial, suggesting that the model structures, input parameters, and assumptions about breast cancer natural history are reasonable for estimating the impact of screening on mortality in this age group.

Original languageEnglish
Pages (from-to)140S-150S
JournalMedical Decision Making
Issue number1_suppl
Publication statusPublished - 1 Apr 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017, © The Author(s) 2017.


Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (JJV, NTV, HJD); Department of Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Washington DC, USA (JSM); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA (ESB); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA (MAE, OA, AT); Department of Radiology, School of Medicine, Stanford University, Stanford, CA, USA (CX, SKP); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard Medical School Boston, Boston, MA, USA (HH, SJL); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA (NKS); Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA (YL, JS); Department of cancer prevention, Wolfson Institute, Queen Mary University of London, London, UK (SMM). This work was supported by the National Institutes of Health under National Cancer Institute Grants U01CA152958 and U01CA199218.

FundersFunder number
National Institutes of Health
National Cancer InstituteU01CA199218, U01CA152958


    • breast cancer models
    • CISNET
    • external validation
    • mammography trial simulation


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