Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer

Abstract

The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.

Breast Imaging in the Era of Big Data: Structured Reporting and Data Mining

“…The concept of big data makes possible the integration of current, previous, and future breast examination data with a multitude of other data sources, such as electronic health records, genomic analysis, and lifestyle tracking. This integration can make future breakthroughs in risk modeling and disease detection possible [36]. To realize these breakthroughs, breast imagers and data engineers will need to collaborate.…”

The Potential Impact of Risk-Based Screening Mammography in Women 40–49 Years Old

“…Family history of breast cancer and increased breast density are known to increase the risk of breast cancer [30][31][32], and some authors have suggested using these parameters to determine who should be screened [23,29]. In particular, first-degree family history has been emphasized as a criterion for risk-based screening [27], and prior studies evaluating risk depending on degree of family history of breast cancer have used a stratification strategy similar to ours [28].…”

“…Because of its emphasis on patient context, this qualification reignited interest in a risk-based approach to screening mammography in women younger than 50 years old [10,[23][24][25][26][27][28]. Specifically, it has been suggested that routine screening mammography be used for 40-to 49-year-old women only when there is a family history of breast cancer or dense breasts (or both) [23,29], because these factors are known to increase the risk of breast cancer [30][31][32]. …”

Sobrediagnóstico en cribado de cáncer

“…Las estimaciones son tan variables como los méto-dos para estimarlo 22 . A pesar de las intensas estrategias de cribado, la mortalidad asociada a cáncer de mama no letal ha disminuido el 8%, mientras que la mortalidad por cáncer de mama en general se ha reducido en un 28%.…”