title: Development of a protocol for evaluation of mammographic surveillance services in women under 50 with a family history of breast cancer.
abstract: BACKGROUND
  Preliminary retrospective data suggest it is possible to identify impalpable breast cancer in women presenting with a family history of breast cancer under the age of 50, by using regular mammography. In consequence, this service is offered in a number of centres in the UK. The effectiveness of such a service, however, has not been fully evaluated.
  
  
  METHODS
  We propose to perform such an evaluation in a cohort of 20000 women under the age of 50 with a significant family history of breast cancer, given regular mammographic surveillance over 5 years. Comparison of surgical and pathological data with completed and ongoing population screening trials using analysis techniques of varying complexity will be performed to obtain an accurate prediction of future breast-cancer mortality reduction. The formal aims are: i) to estimate the difference in breast-cancer mortality in women under the age of 50 with a significant family history of breast cancer having regular mammography, compared with those not being screened; ii) to estimate the cost-effectiveness of regular mammography in this group of women, compared with no screening. The increase in health service resource use attributable to such a policy will be compared with no screening, and costed. Incremental cost-effectiveness ratios of implementing the standardised mammography strategy compared with no screening will be presented in terms of the additional cost per cancer detected, per life saved and per life-year saved.
authors.affiliation: North East Thames Regional Genetics Service, Institute of Child Health, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Mackay
authors.forename: C
authors.initials: C
authors.lastname: Rogers
authors.forename: H
authors.initials: H
authors.lastname: Fielder
authors.forename: R
authors.initials: R
authors.lastname: Blamey
authors.forename: D
authors.initials: D
authors.lastname: Macmillan
authors.forename: C
authors.initials: C
authors.lastname: Boggis
authors.forename: J
authors.initials: J
authors.lastname: Brown
authors.forename: P D
authors.initials: PD
authors.lastname: Pharoah
authors.forename: S
authors.initials: S
authors.lastname: Moss
authors.forename: N E
authors.initials: NE
authors.lastname: Day
authors.forename: J
authors.initials: J
authors.lastname: Myles
authors.forename: J
authors.initials: J
authors.lastname: Austoker
authors.forename: J
authors.initials: J
authors.lastname: Gray
authors.forename: J
authors.initials: J
authors.lastname: Cuzick
authors.forename: S W
authors.initials: SW
authors.lastname: Duffy
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics / Q000379:methods / Q000592:standards*; D008403:Mass Screening / Q000191:economics / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D016730:Program Development; D012307:Risk Factors