Breast cancer screening, outside the population-screening program, of women from breast cancer families without proven BRCA1/BRCA2 mutations: a simulation study.
OBJECTIVE
We assessed the cost-effectiveness of mammography screening for women under the age of 50, from breast cancer families without proven BRCA1/BRCA2 mutations, because current criteria for screening healthy women from breast cancer families are not evidence-based.


METHODS
We did simulation studies with mathematical models on the cost-effectiveness of mammography screening of women under the age of 50 with breast cancer family histories. Breast cancer screening was simulated with varying screening intervals (6, 12, 18, and 24 months) and screening cohorts (starting at ages 30, 35, 40, and 45, and continuing to age 50). Incremental costs of screening were compared with those of women ages 50 to 52 years, the youngest age group currently routinely screened in the nationwide screening program of the Netherlands, to determine cost-effectiveness. Sensitivity analyses were done to explore the effects of model assumptions. The cost-effectiveness of breast cancer screening for women over the age of 50 was not debated.


RESULTS
The most effective screening interval was found to be 12 months, which, however, seems only to be cost-effective in a small group of women under the age of 50 with at least two affected relatives, including at least one affected in the first degree diagnosed under the age of 50. Significantly, early breast cancer screening never seemed to be cost-effective in women with only one affected first-degree or second-degree relative.


CONCLUSIONS
Annual breast cancer screening with mammography for women under the age of 50 seems to be cost-effective in women with strong family histories of breast cancer, even when no BRCA1/BRCA2 mutation was found in affected family members.
Jacobi
Catharina E
CE
Department of Medical Decision Making (J10-S), Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands. c.e.jacobi@lumc.nl
Nagelkerke
Nico J D
NJ
van Houwelingen
J Hans C
JH
de Bock
Geertruida H
GH
D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000235:genetics*; D003362:Cost-Benefit Analysis; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D008962:Models, Theoretical; D009154:Mutation; D009426:Netherlands / Q000453:epidemiology; D016544:Patient Simulation; D010375:Pedigree; D015995:Prevalence; D018570:Risk Assessment; D015996:Survival Rate