Development of a protocol for evaluation of mammographic surveillance services in women under 50 with a family history of breast cancer.
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.
Mackay
J
J
North East Thames Regional Genetics Service, Institute of Child Health, London, UK.
Rogers
C
C
Fielder
H
H
Blamey
R
R
Macmillan
D
D
Boggis
C
C
Brown
J
J
Pharoah
P D
PD
Moss
S
S
Day
N E
NE
Myles
J
J
Austoker
J
J
Gray
J
J
Cuzick
J
J
Duffy
S W
SW
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