8th European Breast Cancer Conference - March 21-24, Vienna
Cost of MRI screening for women with a family history of breast cancer
Dr Sepideh Saadatmand – Erasmus University Medical Centre, Rotterdam, Netherlands
First of all, thank you very much for this opportunity to present our work on cost effectiveness of screening women with familial risk for breast cancer with MRI.
Approximately 15-20% of all female breast cancers occur in women with a family history of breast cancer without a dominant gene mutation found. These women are often annually screened with mammography to reduce mortality rates. MRI can often detect invasive cancer earlier when added to this screening programme and has been considered cost-effective for BRCA1 and BRCA2 mutation carriers. However, the cost effectiveness of MRI for women with a familial risk remains unclear.
We analysed data of the Dutch MRI screening study; we used the data of the women with a cumulative lifetime risk of 15-50% in this multi-centre study that ran from 1999 until 2007. Women aged 25 to 70 years were screened every six months with clinical breast examination and annually with mammography and MRI.
We calculated the costs for detected cancer treated and used the current prices to do so. In this table these prices are depicted. If you look in the most left column, you will see the age category in years of the women that were screened in this study. Next to that you will find the number of carcinomas per age category; then you will find the women years at risk and in the most right column the mean total cost, these are the total costs of screening, diagnosis and treatment divided by the number of carcinomas found in that age category. So these are the costs per detected cancer treated.
If we look overall in all the age categories, we will see that the costs per detected cancer treated are approximately €111,000. If we look in the age category, the oldest age category, above 60 years, we see costs are quite reasonable with approximately €50,000 however, if we look at the age category of 40-50, these costs double and the cost doubles again in the age category of 30-40. This is probably due to a lower incidence of breast cancer in the younger age categories.
We’ve used these numbers to incorporate them in a micro-simulation programme in which we can simulate different screening programmes with different time intervals. That way we can calculate the costs per life year gained. If we look at the costs per life year gained of MRI added to the screening programme with mammography, we see costs per life year gained are approximately twice as high.
In conclusion, adding MRI to screening is expensive, especially in the youngest age categories. However, it’s possibly most beneficial also in these youngest age categories. The reason for that is breast density; breast density is related to the incidence of breast cancer – the higher the breast density, which is often the case in young patients, the higher the risk of breast cancer. And breast density is also related to a decrease of the sensitivity of mammography. It is therefore necessary to identify subgroups of women for whom MRI might be beneficial and cost effective. To do so a randomised controlled trial is needed; such a trial is currently being performed in the Netherlands. The Familial MRI Screening Study, FAMRISS, is the Dutch multi-centre randomised controlled trial in which women aged 35-60 years with a cumulative lifetime risk of above 20% due to their family history are randomised in two groups. They are screened either with yearly mammography and clinical breast examination or with yearly MRI and clinical breast examination and mammography bi-annually.
Thank you for your attention.