Cost-effectiveness of screening women with familial risk for breast cancer with magnetic resonance imaging.
BACKGROUND
To reduce mortality, women with a family history of breast cancer are often screened with mammography before age 50 years. Additional magnetic resonance imaging (MRI) improves sensitivity and is cost-effective for BRCA1/2 mutation carriers. However, for women with a family history without a proven mutation, cost-effectiveness is unclear.


METHODS
We evaluated data of the largest prospective MRI screening study (MRISC). Between 1999 and 2007, 1597 women (8370 woman-years at risk) aged 25 to 70 years with an estimated cumulative lifetime risk of 15% to 50% for breast cancer were screened with clinical breast examination every 6 months and with annual mammography and MRI. We calculated the cost per detected and treated breast cancer. After incorporating MRISC data into a microsimulation screening analysis model (MISCAN), different schemes were evaluated, and cost per life-year gained (LYG) was estimated in comparison with the Dutch nationwide breast cancer screening program (biennial mammography from age 50 to 75 years). All statistical tests were two-sided.


RESULTS
Forty-seven breast cancers (9 ductal carcinoma in situ) were detected. Screening with additional MRI costs $123 672 (€93 639) per detected breast cancer. In increasing age-cohorts, costs per detected and treated breast cancer decreased, but, unexpectedly, the percentage of MRI-only detected cancers increased. Screening under the MRISC-scheme from age 35 to 50 years was estimated to reduce breast cancer mortality by 25% at $134 932 (€102 164) per LYG (3.5% discounting) compared with 17% mortality reduction at $54 665 (€41 390) per LYG with mammography only.


CONCLUSIONS
Screening with MRI may improve survival for women with familial risk for breast cancer but is expensive, especially in the youngest age categories.
Department of Surgery, Erasmus Medical Center, Rotterdam, Netherlands.
Sepideh
S
Saadatmand
Madeleine M A
MM
Tilanus-Linthorst
Emiel J T
EJ
Rutgers
Nicoline
N
Hoogerbrugge
Jan C
JC
Oosterwijk
Rob A E M
RA
Tollenaar
Maartje
M
Hooning
Claudette E
CE
Loo
Inge-Marie
IM
Obdeijn
Eveline A M
EA
Heijnsdijk
Harry J
HJ
de Koning
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology / Q000235:genetics; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D005190:Family; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008327:Mammography; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008487:Medical History Taking; D008875:Middle Aged; D009154:Mutation; D009426:Netherlands / Q000453:epidemiology; D010173:Palpation; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors