Experiences, expectations and preferences regarding MRI and mammography as breast cancer screening tools in women at familial risk

Geuzinge, H Amarens; Heijnsdijk, Eveline A.M.; Obdeijn, Inge-Marie; Koning, Harry J. de; Tilanus-Linthorst, Madeleine M.A.

doi:10.1016/j.breast.2021.01.002

Cited by 13 publications

(6 citation statements)

References 12 publications

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“…Cost-effectiveness analyses of breast MRI and mammography to date have not included the downstream costs of MRI extramammary findings in their assessments and are overall less comprehensive in their examination of events. 25,[35][36][37] Differences in out-of-pocket spending from cascades are critical to share with women when making decisions about breast cancer screening approaches, especially given growing enrollment in high deductible health plans. 29,38 Our findings about additional mammary and extramammary cascade events associated with MRI contribute to understanding the potential benefits and harms of these studies.…”

Section: Discussionmentioning

confidence: 99%

Downstream Mammary and Extramammary Cascade Services and Spending Following Screening Breast Magnetic Resonance Imaging vs Mammography Among Commercially Insured Women

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Downstream Mammary and Extramammary Cascade Services and Spending Following Screening Breast Magnetic Resonance Imaging vs Mammography Among Commercially Insured Women

et al. 2022

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“…Still, our discomfort scores for mammography are in line with the reported means for pain in other studies, which vary between 4 and 7 (scale 0-11) (37)(38)(39). While discomfort associated to mammography is mostly associated to pain provoked by the plates that compress the breasts, discomfort associated to breast MRI is a result of intravenous contrast injection and lying on an MRI table while being subject to intermittent loud noises for about one hour (40)(41)(42)(43)(44). And while these breast imaging disadvantages have been reported by women who have undergone these imaging techniques, it could be a reason for women to not comply to screening.…”

Section: Discussionmentioning

confidence: 99%

Patient-centered research: how do women tolerate nipple fluid aspiration as a potential screening tool for breast cancer?

Patuleia

Moelans

Koopman

et al. 2022

Preprint

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Background: Nipple fluid aspiration (NFA) is a technique to acquire nipple aspirate fluid (NAF), which is considered a rich source of breast-specific biomarkers. Originating directly from the mammary ducts, this liquid biopsy can offer insight into the process of carcinogenesis at its earliest stage and therefore could be of added value to the current imaging-based breast cancer screening tools. With that in mind, it is necessary to know how well NFA is tolerated.Aim: To evaluate the participants’ tolerability of NFA compared to breast imaging screening methods and blood draws.Materials and methods: Three cohorts of women underwent NFA: healthy women (n=190), women diagnosed with breast cancer (n=137) and women at high risk of developing breast cancer (n=48). A 0-10 discomfort score of NFA, mammography, breast MRI and blood draws, was filled in at the study visits, which took place once or annually.Results: The median discomfort rate of NFA was 1, which was significantly lower than the median discomfort of mammography and breast MRI (5 and 3, respectively, p<0.001), but significantly higher than median discomfort for blood draws (0, p<0.001). The great majority of women would undergo the procedure again (98%) and recommend it to others (97%).Conclusion: This study shows that NFA was well tolerated by healthy women, women diagnosed with breast cancer and high-risk women. This makes NFA a feasible method to pursue as a potential future breast cancer early detection tool, based on resident biomarkers.Trial registration: NL41845.041.12, NL57343.041.16 and NL11690.041.06 in trialregister.nl

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“…47 We assigned a disutility for BC surveillance attendance for year of screening and a 1-year disutility for a false-positive result. 45,48 OC and BC utility scores were derived from published literature [49][50][51][52] (eTable 2 and eMethods 4 in Supplement 1). All utility scores were age adjusted using the multiplicative method, 53 combining age-specific utility scores in the healthy state 54 with utilities in all other health states.…”

Section: Quality-adjusted Life-yearsmentioning

confidence: 99%

Cost-Effectiveness of Gene-Specific Prevention Strategies for Ovarian and Breast Cancer

Wei,

Sun,

Slade

et al. 2024

JAMA Netw Open

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ImportancePathogenic variants (PVs) in BRCA1, BRCA2, PALB2, RAD51C, RAD51D, and BRIP1 cancer susceptibility genes (CSGs) confer an increased ovarian cancer (OC) risk, with BRCA1, BRCA2, PALB2, RAD51C, and RAD51D PVs also conferring an elevated breast cancer (BC) risk. Risk-reducing surgery, medical prevention, and BC surveillance offer the opportunity to prevent cancers and deaths, but their cost-effectiveness for individual CSGs remains poorly addressed.ObjectiveTo estimate the cost-effectiveness of prevention strategies for OC and BC among individuals carrying PVs in the previously listed CSGs.Design, Setting, and ParticipantsIn this economic evaluation, a decision-analytic Markov model evaluated the cost-effectiveness of risk-reducing salpingo-oophorectomy (RRSO) and, where relevant, risk-reducing mastectomy (RRM) compared with nonsurgical interventions (including BC surveillance and medical prevention for increased BC risk) from December 1, 2022, to August 31, 2023. The analysis took a UK payer perspective with a lifetime horizon. The simulated cohort consisted of women aged 30 years who carried BRCA1, BRCA2, PALB2, RAD51C, RAD51D, or BRIP1 PVs. Appropriate sensitivity and scenario analyses were performed.ExposuresCSG-specific interventions, including RRSO at age 35 to 50 years with or without BC surveillance and medical prevention (ie, tamoxifen or anastrozole) from age 30 or 40 years, RRM at age 30 to 40 years, both RRSO and RRM, BC surveillance and medical prevention, or no intervention.Main Outcomes and MeasuresThe incremental cost-effectiveness ratio (ICER) was calculated as incremental cost per quality-adjusted life-year (QALY) gained. OC and BC cases and deaths were estimated.ResultsIn the simulated cohort of women aged 30 years with no cancer, undergoing both RRSO and RRM was most cost-effective for individuals carrying BRCA1 (RRM at age 30 years; RRSO at age 35 years), BRCA2 (RRM at age 35 years; RRSO at age 40 years), and PALB2 (RRM at age 40 years; RRSO at age 45 years) PVs. The corresponding ICERs were −£1942/QALY (−$2680/QALY), −£89/QALY (−$123/QALY), and £2381/QALY ($3286/QALY), respectively. RRSO at age 45 years was cost-effective for RAD51C, RAD51D, and BRIP1 PV carriers compared with nonsurgical strategies. The corresponding ICERs were £962/QALY ($1328/QALY), £771/QALY ($1064/QALY), and £2355/QALY ($3250/QALY), respectively. The most cost-effective preventive strategy per 1000 PV carriers could prevent 923 OC and BC cases and 302 deaths among those carrying BRCA1; 686 OC and BC cases and 170 deaths for BRCA2; 464 OC and BC cases and 130 deaths for PALB2; 102 OC cases and 64 deaths for RAD51C; 118 OC cases and 76 deaths for RAD51D; and 55 OC cases and 37 deaths for BRIP1. Probabilistic sensitivity analysis indicated both RRSO and RRM were most cost-effective in 96.5%, 89.2%, and 84.8% of simulations for BRCA1, BRCA2, and PALB2 PVs, respectively, while RRSO was cost-effective in approximately 100% of simulations for RAD51C, RAD51D, and BRIP1 PVs.Conclusions and RelevanceIn this cost-effectiveness study, RRSO with or without RRM at varying optimal ages was cost-effective compared with nonsurgical strategies for individuals who carried BRCA1, BRCA2, PALB2, RAD51C, RAD51D, or BRIP1 PVs. These findings support personalizing risk-reducing surgery and guideline recommendations for individual CSG-specific OC and BC risk management.

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Experiences, expectations and preferences regarding MRI and mammography as breast cancer screening tools in women at familial risk

Abstract: , on behalf of the FaMRIsc study group

Cited by 13 publications

References 12 publications

Downstream Mammary and Extramammary Cascade Services and Spending Following Screening Breast Magnetic Resonance Imaging vs Mammography Among Commercially Insured Women

Downstream Mammary and Extramammary Cascade Services and Spending Following Screening Breast Magnetic Resonance Imaging vs Mammography Among Commercially Insured Women

Patient-centered research: how do women tolerate nipple fluid aspiration as a potential screening tool for breast cancer?

Cost-Effectiveness of Gene-Specific Prevention Strategies for Ovarian and Breast Cancer

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