Cost-Effectiveness of Magnetic Resonance Imaging Screening for Women With Extremely Dense Breast Tissue

Geuzinge, H Amarens; Bakker, Marije F.; Heijnsdijk, Eveline A.M.; Ravesteyn, Nicolien T. van; Veldhuis, Wouter B.; Pijnappel, Ruud M.; Lange, Stéphanie V de; Emaus, Marleen J.; Mann, Ritse M.; Monninkhof, Evelyn M.; Koekkoek‐Doll, Petra K. de; Gils, Carla H. van; Koning, Harry J. de

doi:10.1093/jnci/djab119

Cited by 49 publications

(36 citation statements)

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“…The results of the DENSE trial have been modelled in a microsimulation model (MISCAN) to determine the longterm impact of offering breast MRI screening to women with extremely dense breasts [33]. This model was also used to explore other scenarios, for which the model used the measured sensitivity and specificity of mammography and MRI as observed in the DENSE trial, plus the estimated biological behavior of breast cancers, and information on the efficacy of treatment of breast cancers obtained from historical data.…”

Section: Current Evidence On Breast Cancer Screening In Women With De...mentioning

confidence: 99%

“…As the costs of MRI screening are mostly influenced by the cost of the MR scans [33], there is strong interest in breast MRI with shorter scan protocols, generally referred to as abbreviated breast MRI. This may enable a higher throughput and therefore a lower cost per examination.…”

Section: Current Evidence On Breast Cancer Screening In Women With De...mentioning

confidence: 99%

“…Based on the modelled results of the DENSE trial [31,33] This reduced mortality, and potentially less aggressive treatment, comes at a price.…”

Section: How To Explain the Advantages Associated With Breast Mri Scr...mentioning

confidence: 99%

“…Based on the modelled DENSE data, about 25% of mammographically detected cancers (in 1.7% of women) and about 22% of MRI detected cancers (in 2.1% of women) may represent overdiagnosis [33]. These are mainly the low grade in situ, and some very indolent invasive breast cancers.…”

Section: Third the Possibility Of Overdiagnosismentioning

confidence: 99%

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Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI)

et al. 2022

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Breast density is an independent risk factor for the development of breast cancer and also decreases the sensitivity of mammography for screening. Consequently, women with extremely dense breasts face an increased risk of late diagnosis of breast cancer. These women are, therefore, underserved with current mammographic screening programs. The results of recent studies reporting on contrast-enhanced breast MRI as a screening method in women with extremely dense breasts provide compelling evidence that this approach can enable an important reduction in breast cancer mortality for these women and is cost-effective. Because there is now a valid option to improve breast cancer screening, the European Society of Breast Imaging (EUSOBI) recommends that women should be informed about their breast density. EUSOBI thus calls on all providers of mammography screening to share density information with the women being screened. In light of the available evidence, in women aged 50 to 70 years with extremely dense breasts, the EUSOBI now recommends offering screening breast MRI every 2 to 4 years. The EUSOBI acknowledges that it may currently not be possible to offer breast MRI immediately and everywhere and underscores that quality assurance procedures need to be established, but urges radiological societies and policymakers to act on this now. Since the wishes and values of individual women differ, in screening the principles of shared decision-making should be embraced. In particular, women should be counselled on the benefits and risks of mammography and MRI-based screening, so that they are capable of making an informed choice about their preferred screening method. Key Points • The recommendations in Figure 1 summarize the key points of the manuscript

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Section: Current Evidence On Breast Cancer Screening In Women With De...mentioning

confidence: 99%

Section: Current Evidence On Breast Cancer Screening In Women With De...mentioning

confidence: 99%

“…Based on the modelled results of the DENSE trial [31,33] This reduced mortality, and potentially less aggressive treatment, comes at a price.…”

Section: How To Explain the Advantages Associated With Breast Mri Scr...mentioning

confidence: 99%

Section: Third the Possibility Of Overdiagnosismentioning

confidence: 99%

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Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI)

et al. 2022

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“…Although the biopsy is simple to perform, the number of steps to get the specimens is time-consuming as it is not a real-time procedure. 20 - 23 …”

Section: Discussionmentioning

confidence: 99%

Management of Non-Mass Enhancement at Breast Magnetic Resonance in Screening Settings Referred for Magnetic Resonance-Guided Biopsy

Fleury

Castro²,

Amaral³

et al. 2022

Breast Cancer�(Auckl)

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Rationale and Objectives: According to the Breast Imaging and Reporting Data System (BI-RADS), one of the main limitations of MRI is diagnosing the non-mass enhancement (NME). The NME lesion is challenging since it is unique to the MRI lexicon. This study aims to report our experience with NME lesions diagnosed by MRI referred for MRI-guided biopsies and discuss the management and follow-up of these lesions. Materials and Methods: We retrospectively evaluated all MRI-guide breast biopsies. We included all patients referred for NME breast MRI-guided biopsy in screening settings. All patients had a negative second-look mammography or ultrasonography. We correlated the distribution and internal enhancement pattern (IEP) of the NME lesions with histology. Invasive ductal carcinomas (IDC) of no special type and ductal carcinoma in situ (DCIS) were considered malignant lesions. Results: From January-2018 to July-2021, we included 96 women with a total of 96 lesions in the study. There were 90 benign and 6 malignant lesions with DCIS prevalence (5/6 cancers). The most frequent benign lesion type was fibrocystic changes. There were no NME lesions with diffuse or multiple area distribution features referred to MRI-guided biopsy. The positive-predictive values (PPV) were respectively 0.0%, 2.5%, 9.0%, and 11.0% for linear, focal, regional, and segmental distribution describers, and 0.0, 3.0%, 7.9%, and 50% for homogenous, heterogeneous, clumped, and clustered-ring enhancement patterns. Conclusion: We observe the high potential risk for malignancy in the clustered-ring enhancement followed by the clumped pattern. Segmental distribution presented the highest predictive-positive values.

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Breast Cancer Screening Using Mammography, Digital Breast Tomosynthesis, and Magnetic Resonance Imaging by Breast Density

Stout,

Miglioretti,

et al. 2024

JAMA Intern Med

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ImportanceInformation on long-term benefits and harms of screening with digital breast tomosynthesis (DBT) with or without supplemental breast magnetic resonance imaging (MRI) is needed for clinical and policy discussions, particularly for patients with dense breasts.ObjectiveTo project long-term population-based outcomes for breast cancer mammography screening strategies (DBT or digital mammography) with or without supplemental MRI by breast density.Design, Setting, and ParticipantsCollaborative modeling using 3 Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer simulation models informed by US Breast Cancer Surveillance Consortium data. Simulated women born in 1980 with average breast cancer risk were included. Modeling analyses were conducted from January 2020 to December 2023.InterventionAnnual or biennial mammography screening with or without supplemental MRI by breast density starting at ages 40, 45, or 50 years through age 74 years.Main outcomes and MeasuresLifetime breast cancer deaths averted, false-positive recall and false-positive biopsy recommendations per 1000 simulated women followed-up from age 40 years to death summarized as means and ranges across models.ResultsBiennial DBT screening for all simulated women started at age 50 vs 40 years averted 7.4 vs 8.5 breast cancer deaths, respectively, and led to 884 vs 1392 false-positive recalls and 151 vs 221 false-positive biopsy recommendations, respectively. Biennial digital mammography had similar deaths averted and slightly more false-positive test results than DBT screening. Adding MRI for women with extremely dense breasts to biennial DBT screening for women aged 50 to 74 years increased deaths averted (7.6 vs 7.4), false-positive recalls (919 vs 884), and false-positive biopsy recommendations (180 vs 151). Extending supplemental MRI to women with heterogeneously or extremely dense breasts further increased deaths averted (8.0 vs 7.4), false-positive recalls (1088 vs 884), and false-positive biopsy recommendations (343 vs 151). The same strategy for women aged 40 to 74 years averted 9.5 deaths but led to 1850 false-positive recalls and 628 false-positive biopsy recommendations. Annual screening modestly increased estimated deaths averted but markedly increased estimated false-positive results.Conclusions and relevanceIn this model-based comparative effectiveness analysis, supplemental MRI for women with dense breasts added to DBT screening led to greater benefits and increased harms. The balance of this trade-off for supplemental MRI use was more favorable when MRI was targeted to women with extremely dense breasts who comprise approximately 10% of the population.

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Cost-Effectiveness of Magnetic Resonance Imaging Screening for Women With Extremely Dense Breast Tissue

Cited by 49 publications

References 28 publications

Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI)

Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI)

Management of Non-Mass Enhancement at Breast Magnetic Resonance in Screening Settings Referred for Magnetic Resonance-Guided Biopsy

Breast Cancer Screening Using Mammography, Digital Breast Tomosynthesis, and Magnetic Resonance Imaging by Breast Density

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