title: Personalizing mammography by breast density and other risk factors for breast cancer: analysis of health benefits and cost-effectiveness.
abstract: BACKGROUND
  Current guidelines recommend mammography every 1 or 2 years starting at age 40 or 50 years, regardless of individual risk for breast cancer.
  
  
  OBJECTIVE
  To estimate the cost-effectiveness of mammography by age, breast density, history of breast biopsy, family history of breast cancer, and screening interval.
  
  
  METHODS
  Markov microsimulation model.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results program, Breast Cancer Surveillance Consortium, and the medical literature.
  
  
  METHODS
  U.S. women aged 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years with initial mammography at age 40 years and breast density of Breast Imaging Reporting and Data System (BI-RADS) categories 1 to 4.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  National health payer.
  
  
  METHODS
  Mammography annually, biennially, or every 3 to 4 years or no mammography.
  
  
  METHODS
  Costs per quality-adjusted life-year (QALY) gained and number of women screened over 10 years to prevent 1 death from breast cancer.
  
  
  RESULTS
  Biennial mammography cost less than $100,000 per QALY gained for women aged 40 to 79 years with BI-RADS category 3 or 4 breast density or aged 50 to 69 years with category 2 density; women aged 60 to 79 years with category 1 density and either a family history of breast cancer or a previous breast biopsy; and all women aged 40 to 79 years with both a family history of breast cancer and a previous breast biopsy, regardless of breast density. Biennial mammography cost less than $50,000 per QALY gained for women aged 40 to 49 years with category 3 or 4 breast density and either a previous breast biopsy or a family history of breast cancer. Annual mammography was not cost-effective for any group, regardless of age or breast density.
  
  
  RESULTS
  Mammography is expensive if the disutility of false-positive mammography results and the costs of detecting nonprogressive and nonlethal invasive cancer are considered.
  
  
  CONCLUSIONS
  Results are not applicable to carriers of BRCA1 or BRCA2 mutations.
  
  
  CONCLUSIONS
  Mammography screening should be personalized on the basis of a woman's age, breast density, history of breast biopsy, family history of breast cancer, and beliefs about the potential benefit and harms of screening.
  
  
  BACKGROUND
  Eli Lilly, Da Costa Family Foundation for Research in Breast Cancer Prevention of the California Pacific Medical Center, and Breast Cancer Surveillance Consortium.
authors: Park Nicollet Health Services, Minneapolis, Minnesota 55416, USA. scho0600@umn.edu
authors: John T
authors: JT
authors: Schousboe
authors: Karla
authors: K
authors: Kerlikowske
authors: Andrew
authors: A
authors: Loh
authors: Steven R
authors: SR
authors: Cummings
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001940:Breast / Q000033:anatomy & histology* / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000235:genetics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D005189:False Positive Reactions; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D008390:Markov Chains; D008403:Mass Screening / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors