Cost-Effectiveness of Lifestyle-Related Interventions for the Primary Prevention of Breast Cancer: A Rapid Review

Abstract

Background: In 2018, the global estimate of newly diagnosed breast cancer cases among women totaled 2.1 million. The economic and social burden that breast cancer places on societies has propelled research that analyzes the role of modifiable risk factors as the primary prevention methods. Healthy behavior changes, moderated alcohol intake, healthy body weight, and regular physical activity may decrease the risk of breast cancer among women. This review aimed to synthesize evidence on the cost-effectiveness of lifestyle-related interventions for the primary prevention of breast cancer in order to answer the question on whether implementing interventions focused on behavior changes are worth the value for money.Methods: A rapid review was performed using search terms developed by the research team. The articles were retrieved from MEDLINE and the Tufts Medical Center Cost-Effectiveness Analysis Registry, with an additional web search in Google and Google Scholar. Comparisons were performed on the cost-effectiveness ratio per quality-adjusted life-year between the interventions using a league table, and the likelihood of cost-effective interventions for breast cancer primary prevention was analyzed.Results: Six studies were selected. The median cost-effectiveness ratio (in 2018 USD) was $24,973, and 80% of the interventions had a ratio below the $50,000 threshold. The low-fat-diet program for postmenopausal women was cost-effective at a societal level, and the physical activity interventions, such as the Be Active Program in the UK, had the best cost saving results. A total of 11 of the 25 interventions ranked either as highly or very highly likely to be cost-effective for breast cancer primary preventions.Conclusion: Although the review had some limitations due to using only a few studies, it showed evidence that diet-related and physical-activity-related interventions for the primary prevention of breast cancer were cost-effective. Many of the cost-effective interventions aimed to reduce the risk of non-communicable diseases alongside breast cancer.

Effects of Major Lifestyle Factors on Breast Cancer Risk: Impact of Weight, Nutrition, Physical Activity, Alcohol and Tobacco

“…In that study, compared with parous nonsmokers, parous smokers who smoked more than 5 years before their first live childbirth had a 31% overall higher risk of BC (HR: 1.31; 95% CI: 1.14-1.51). This higher risk was similar across racial/ethnic groups and by ER and PR status [101]. The results of other recent cohort studies support the notion that women who start smoking as teenagers and continue until they get pregnant have a higher risk of BC.…”

Tackling the cancer burden: the economic impact of primary prevention policies

“…via reduced absenteeism), have not been included. These findings also correspond with previous analyses which conclude there is a robust economic case for implementing primary prevention policies targeting risk factors [39–42].…”

Looking beyond the Lamppost: Population-Level Primary Prevention of Breast Cancer

“…Environmental and behavioral factors are associated with 90 to 95 percent of breast cancer cases [ 6 , 13 ]. Behavioral risk factors have been given considerable attention in the literature [ 1 , 11 , 13 , 21 , 22 , 23 , 24 , 25 ], with healthy diet (avoiding high calorie foods, processed meat, and alcohol consumption) and weight management as the most often discussed.…”

“…Age Increase in risk with increase in age [34] Age at first birth Older age increases overall risk and breast cancer density risk [34] Age at menarche Earlier age increases overall risk [34] Age at menopause Later age increases overall risk [34] Breast density Increases overall risk [34] Family history Increases overall risk [34] Race/Ethnicity Physical activity Decreases overall risk, as well as risk for obesity [25,47,50] Tobacco use Increases overall risk [7] Exposure to light at night/sleep loss Increases overall risk through disruption of sleep cycle, hormone release [7] Total suspended particles (TSP) Increases overall risk [6,12,[29][30][31] Chemical exposures (gasoline, exhaust, PCB, DDT, PAH, EDC) Increases overall risk [6,12,[29][30][31] Windows of susceptibility (WOS)…”