{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:59:48Z","timestamp":1792789188710,"version":"4.5.0"},"reference-count":41,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Institute for Quality and Efficiency in Health Care","award":["S21-01"],"award-info":[{"award-number":["S21-01"]}],"id":[{"id":"https:\/\/ror.org\/02qz3vm75","id-type":"ROR","asserted-by":"crossref"}]},{"award":["S21-01"],"award-info":[{"award-number":["S21-01"]}],"id":[{"id":"https:\/\/ror.org\/02qz3vm75","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: To inform policy making for the German breast cancer (BC) screening program, we systematically evaluated the long-term benefits and harms of extended age limits compared to the current standard of biennial mammography at ages 50\u201369 years using a decision-analytic approach. Methods: We developed and applied a Markov state-transition model for mammography screening in Germany to systematically assess the benefit\u2013harm trade-offs of various screening strategies varying in age at start and end of screening as well as in screening frequency. The model was populated with international data for sensitivity and specificity of mammography along with German epidemiological, clinical and age-specific quality-of-life data. In deterministic analyses, the following outcomes were projected: detected ductal carcinoma in situ (DCIS) and invasive BC, BC-related deaths, life years (LY), and quality-adjusted life years (QALY), number of positive, false-positive, and total mammograms, overdiagnosis, and the incremental harm\u2013benefit ratio (IHBR). Results: In the base-case analysis, mammography at ages 45\u201379 (annual, age 45\u201349; biennial, 50\u201379) achieved the highest gain in LY (10.0 life years gained [LYG] per 100 women) compared with current screening. Biennial mammography at ages 45\u201374 resulted in the highest benefits considering both life expectancy and quality of life (3.5 QALYs gained\/100 women). Compared to current biennial mammography screening at ages 50\u201369, lowering the start age from 50 to 45 years resulted in an IHBR of 47 additional mammograms\/LYG. Compared to biennial mammography at ages 45\u201369, biennial mammography at age 45\u201374 results in 96 additional mammograms\/LYG. Further extended screening results in substantially less favorable IHBRs. Conclusions: Based on our results, extending biennial mammography screening to women aged 45 to 74 years may prevent additional BC deaths and increase remaining life expectancy at an acceptable benefit\u2013harm ratio, and improve quality-adjusted life expectancy.<\/jats:p>","DOI":"10.3390\/cancers18172750","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:00:48Z","timestamp":1787644848000},"page":"2750","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Age Limits of Breast Cancer Screening with Mammography\u2014A Decision-Analytic Benefit\u2013Harm Evaluation to Inform Decision Making for the German Context"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5193-0492","authenticated-orcid":false,"given":"Gaby","family":"Sroczynski","sequence":"first","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL\u2014University for Health Sciences and Technology, 6060 Hall in Tirol, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4879-7894","authenticated-orcid":false,"given":"L\u00e1ra","family":"Hallsson","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL\u2014University for Health Sciences and Technology, 6060 Hall in Tirol, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolai","family":"M\u00fchlberger","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL\u2014University for Health Sciences and Technology, 6060 Hall in Tirol, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Felicitas","family":"K\u00fchne","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL\u2014University for Health Sciences and Technology, 6060 Hall in Tirol, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6764-6362","authenticated-orcid":false,"given":"Beate","family":"Jahn","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL\u2014University for Health Sciences and Technology, 6060 Hall in Tirol, Austria"},{"name":"Division of Health Technology Assessment, ONCOTYROL\u2014Center for Personalized Cancer Medicine, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8061-2821","authenticated-orcid":false,"given":"Christin","family":"Henning","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL\u2014University for Health Sciences and Technology, 6060 Hall in Tirol, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Heike","family":"K\u00f6lsch","sequence":"additional","affiliation":[{"name":"Institute for Quality and Efficiency in Health Care (IQWiG), 50679 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1048-796X","authenticated-orcid":false,"given":"Stefan","family":"Sauerland","sequence":"additional","affiliation":[{"name":"Institute for Quality and Efficiency in Health Care (IQWiG), 50679 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1664-3022","authenticated-orcid":false,"given":"Konstanze","family":"Angelescu","sequence":"additional","affiliation":[{"name":"Institute for Quality and Efficiency in Health Care (IQWiG), 50679 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6425-7671","authenticated-orcid":false,"given":"Uwe","family":"Siebert","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL\u2014University for Health Sciences and Technology, 6060 Hall in Tirol, Austria"},{"name":"Division of Health Technology Assessment, ONCOTYROL\u2014Center for Personalized Cancer Medicine, 6020 Innsbruck, Austria"},{"name":"Center for Health Decision Science, Department of Health Policy & Management, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA"},{"name":"Center for Health Technology Assessment, Mass General Brigham, Harvard Medical School, Boston, MA 02145, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (WHO) (2025, August 20). Fact Sheet Breast Cancer. 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