A group of researchers from The Netherlands presented their findings at the eighth European Breast Cancer Conference (EBCC-8) today (Wednesday). They conducted a cost-effectiveness analysis of 1,597 women enrolled in the Dutch MRI Screening Study between 1999 and 2007.
The women in the study group were those who may not have inherited the breast cancer susceptibility genes, but who have a familial risk of developing the disease. Their estimated cumulative lifetime risk for developing breast cancer before the age of 70 was 15 to 20%. The women had a clinical breast examination every six months and an annual mammography and MRI between the ages of 25-70.
The BRCA1/2 gene mutations have been shown to give those with the gene a much higher risk of developing breast cancer, and at an early age. Breast cancer screening programs for those known to have this gene start from a younger age than for the general population. MRI has been shown to be cost-effective for the women who carry this BRCA1/2 mutation. What was not clear until now was whether women who had a simple family history, but did not carry the gene mutation, would also benefit.
Dr Sepideh Saadatmand, who is a physician and PhD student at the Erasmus University Medical Center (Rotterdam, The Netherlands) said :
"We found that it costs approximately three times as much to add MRI to the screening process for every estimated one year of life saved ... When women were screened using clinical breast examinations, mammography and MRI, the cost per detected cancer was about €103,000. We predicted that screening women between the ages of 35-60 in this way would reduce deaths from breast cancer by 24%, at a cost per year of life gained of €30,000. However, if these women were screened by annual mammography and clinical breast examination alone, the estimated reduction in deaths was 20%, at a cost per year of life gained of €10,000."Using data on diagnosis, screening and treatment costs of the women with familial risk, the researchers calculated the cost per detected cancer and estimate the life-years gained. Using computer modeling technique, called micro simulation, they then simulated screening programs with different methods of screening and time intervals.
Dr Saadatmand continues that :
"It is clear from the results of this study that adding MRI to screening programmes for all women with a cumulative life time risk of 15-50% for breast cancer is highly effective, but possibly too expensive. However, it may be cost-effective for a select sub-group ...
The subgroups we expect to benefit from MRI screening are women with a cumulative lifetime risk above 20% due to their family history, who have very dense breast tissue. Breast density may strongly influence screening results, since it increases breast cancer incidence significantly and decreases the sensitivity of mammography, but not of MRI.
Therefore, for women with high breast density, MRI might be cost-effective. There is a multi-centre randomised controlled trial running in The Netherlands to investigate this."
Dr. Saadatmand's randomized controlled trial is still in progress and is expected to finish in 2015. Her team is randomizing women aged between 30-55 with a family history of breast cancer and a cumulative lifetime risk of over 20% for developing the disease, creating two groups:
- 1) annual screening by clinical breast examination and mammography
- 2) annual screening by breast examination and MRI, with a mammography every other year.
Dr Saadatmand concluded:
"The results of the cost-effectiveness study presented today are likely to be of relevance to other countries that have screening programmes similar to The Netherlands, such as the UK and the Scandinavian countries."
Professor David Cameron, from the University of Edinburgh (Edinburgh, UK), and chair of EBCC-8 said:
"This study produces an estimate of the cost-benefit of additional MRI in screening high-risk women. It will inform the important ongoing debate about the role of MRI in screening, particularly for younger women who have a higher-than average lifetime risk of developing breast cancer."
Written by Rupert Shepherd