Marcel Greuter PhD, Presenter: Nothing to Disclose

Geertruida H. De Bock, Abstract Co-Author: Nothing to Disclose

Karin Vermeulen, Abstract Co-Author: Nothing to Disclose

Liesbeth Jansen, Abstract Co-Author: Nothing to Disclose

Jan C Oosterwijk, Abstract Co-Author: Nothing to Disclose

Theo Kok MD, PhD, Abstract Co-Author: Nothing to Disclose

Sabine Siesling, Abstract Co-Author: Nothing to Disclose

For women with a BRCA1 or BRCA2 mutation or a strong family history of breast cancer (BRCAu), the screening strategies in the US, the UK and The Netherlands use different approaches in MRI and mammography. The US strategy is the most intensive where mammography and MRI are performed every year from age 25, the UK strategy is the least intensive where mammography and MRI are done from age 30 every year and only mammography from age 50 to 70 every 3 years, and the Dutch strategy is intermediate. In order to optimize screening, i.e. to find the most effective screening at reasonable costs, the aim of the present study is therefore to evaluate the cost-effectiveness of these screening strategies. 

A recently validated simulation model was applied to the current US, UK and Dutch screening strategies as proposed in their national guidelines. Main outcome were the life years gained, the costs and their ratio, the cost-effectiveness. Cost parameters included were the costs of screening, diagnostics and therapy and hospital stay. Each screening simulation was performed with 10,000 women and the simulation parameters were based on published data.

For BRCA1 and BRCA2 mutation carriers no significant differences in cost-effectiveness were found. However, both the number of life years gained and costs in the Dutch and US screening strategies were significantly higher than in the UK screening strategy. Although the US strategy had the highest costs, no improvement in life years gained was observed as compared to the Dutch screening strategy. For BRCAu women, the most cost effective screening scenario was the UK screening strategy and the least cost effective screening scenario was the US screening strategy (p < 0.05). No significant difference was found in life years gained. However, the US screening strategy showed an excessive increase in costs. 

For women with a BRCA1 or BRCA2 mutation the US, UK and Dutch screening strategies are equally cost-effective, but the number of life years gained was lowest in the UK protocol. For women with only a strong family history of breast cancer the UK screening strategy is the most cost-effective and the US screening strategy is the least cost-effective. 

This study provides information that can be used for optimisation of national screening guidelines for women at an hereditary or familial increased risk of breast cancer.

Greuter, M, De Bock, G, Vermeulen, K, Jansen, L, Oosterwijk, J, Kok, T, Siesling, S, An International Comparison of Cost-effectiveness of Breast Cancer Screening Strategies for Women at Increased Risk.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11008730.html