%0 Journal Article
%T Fewer women aged 35 and older choose serum screening for Down¡¯s syndrome: Impact and implications
%A Geralyn Lambert-Messerlian
%A Glenn E Palomaki
%J Journal of Medical Screening
%@ 1475-5793
%D 2019
%R 10.1177/0969141318797961
%X To quantify changes in the proportion of women aged 35 and older choosing serum screening for Down¡¯s syndrome over time and the effect on false positive and detection rates. From Rhode Island hospital-based laboratory prenatal screening records (2013¨C2017) we extracted the test performed (Integrated, Combined, Quadruple), maternal age, and Down¡¯s syndrome risk; documented observed changes in maternal age distributions and false positive rates, and modelled the impact of varying proportions of older women choosing screening on each test¡¯s performance using the 2015 United States birth cohort as baseline. Over five years, observed false positive rates for Integrated testing declined from 1.9 to 1.3% (£¿32%). The proportion of older women tested declined from 14.9 to 8.5%, from which modelling predicts a 16% decline in the false positive rate. This is lower than our observed change but consistent with a reduction driven by declining participation by older women. Modelling predicted a detection rate reduction from 89 to 87%. Larger detection rate impacts were predicted for Combined and Quadruple testing. This study documents, for the first time, the declining proportion of older women choosing Down¡¯s syndrome serum screening and subsequent impact on screening performance. The American College of Obstetrics and Gynecology recommends offering cell-free DNA screening for these ¡®high risk¡¯ pregnancies and uptake may increase further. Screening programmes could consider increasing use of Integrated testing over other serum screening tests or lowering risk cut-offs so false positive rates approach those of 2012 to regain lost detection
%K Down¡¯s syndrome
%K serum screening
%K maternal age
%K epidemiological monitoring
%K modelling
%U https://journals.sagepub.com/doi/full/10.1177/0969141318797961