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Use of breast MRI can be cost-effective for some women at high-risk of breast cancer
May 24, 2006A computer model simulation suggests that adding breast MRI screening may be cost-effective for women of certain ages who carry BRCA1 and BRCA2 gene mutations, according to a study in the May 24/31 issue of JAMA.
Women who inherit mutations in the BRCA1 or BRCA2 cancer susceptibility genes have a 45 percent to 65 percent lifetime risk of developing breast cancer, according to background information in the article. The risk can be reduced by prophylactic mastectomy but many BRCA1/2 mutation carriers choose instead to seek effective screening strategies that detect breast cancer early. Screening with contrast-enhanced breast magnetic resonance imaging (MRI) has been shown to detect disease earlier than mammography in high-risk women; cancers detected by MRI are often axillary (near the armpit) lymph-node negative and stage I. Although breast MRI screening is highly sensitive, it increases the rate of false-positive test results, and it has not been shown to reduce the death rate from breast cancer. Additionally, breast MRI screening is at least 10 times more expensive than mammographic screening and generates higher diagnostic costs. Because cost may be the greatest barrier to broader evaluation and dissemination of breast MRI screening, its cost-effectiveness is a critical consideration.
Sylvia K. Plevritis, Ph.D., of Stanford University School of Medicine, Stanford, Calif., and colleagues evaluated the cost-effectiveness of adding breast MRI screening in BRCA1/2 mutation carriers. A computer model was used that simulates the life histories of individual BRCA1/2 mutation carriers, incorporating the effects of mammographic and MRI screening. The accuracy of mammography and breast MRI was estimated from published data in high-risk women. Breast cancer survival in the absence of screening was based on the Surveillance, Epidemiology and End Results database of breast cancer patients diagnosed in the prescreening period (1975-1981), adjusted for the current use of supplemental therapy. Utilization rates and costs of diagnostic and treatment interventions were based on a combination of published literature and Medicare payments for 2005.
"At a cost-effectiveness threshold of $100,000 per quality-adjusted life-year gained, adding annual MRI from ages 35 to 54 years is cost-effective among all BRCA1 mutation carriers and among BRCA2 mutation carriers for whom mammography is insensitive. Magnetic resonance imaging has a larger role in screening BRCA1 mutation carriers because they are at greater risk for developing breast cancer and their cancers are more aggressive than those that develop in BRCA2 mutation carriers," the authors write.
The researchers add that screening with MRI becomes more cost-effective as the breast cancer risk increases, mammography performance worsens, greater quality of life gains accrue from MRI and the cost of MRI decreases.
"With substantial declines in its cost, breast MRI screening is likely to represent an acceptable value for a broader group of women."
JAMA and Archives Journals
"At a cost-effectiveness threshold of $100,000 per quality-adjusted life-year gained, adding annual MRI from ages 35 to 54 years is cost-effective among all BRCA1 mutation carriers and among BRCA2 mutation carriers for whom mammography is insensitive. Magnetic resonance imaging has a larger role in screening BRCA1 mutation carriers because they are at greater risk for developing breast cancer and their cancers are more aggressive than those that develop in BRCA2 mutation carriers," the authors write.
The researchers add that screening with MRI becomes more cost-effective as the breast cancer risk increases, mammography performance worsens, greater quality of life gains accrue from MRI and the cost of MRI decreases.
"With substantial declines in its cost, breast MRI screening is likely to represent an acceptable value for a broader group of women."
JAMA and Archives Journals
Breast Cancer News and Current Breast Cancer Events RSSM. D. Anderson study finds change in HER2 status after treatment with Herceptin
Researchers at The University of Texas M. D. Anderson Cancer Center have discovered that when treated with Herceptin prior to surgery, 50 percent of HER2 positive, breast cancer patients showed no signs of disease at the time of surgery.
M. D. Anderson study finds racial disparities in radiation therapy rates for breast cancer
Black women are less likely than white women to receive radiation therapy after a lumpectomy, the standard of care for early stage breast cancer, according to a new study by researchers at The University of Texas M. D. Anderson Cancer Center.
New nano device detects immune system cell signaling
Scientists have detected previously unnoticed chemical signals that individual cells in the immune system use to communicate with each other over short distances.
CSHL scientists identify new drug target against virulent type of breast cancer
Tumor cells in a particular subset of breast cancer patients churn out too much of a protein called ErbB2 -- also often called HER2 -- which drives the cells to proliferate unchecked. Patients unlucky enough to be in this group -- about one in four -- have poorer prognoses and clinical outcomes than those who don't.
Dense tissue promotes aggressive cancers
New research may explain why breast cancer tends to be more aggressive in women with denser breast tissue. Breast cancer cells grown in dense, rigid surroundings step up their invasive activities, Vanderbilt-Ingram Cancer Center investigators report in the Sept. 9 issue of Current Biology.
Women exposed to negative life events at greater risk of breast cancer: BGU study
Happiness and optimism may play a role against breast cancer while adverse life events can increase the risk of developing the disease.
Hormone replacement therapy improves sleep, sexuality and joint pain in older women
One of the world's longest and largest trials of hormone replacement therapy (HRT) has found that post-menopausal women on HRT gain significant improvements in quality of life.
Positive thinking may protect against breast cancer
Feelings of happiness and optimism play a positive role against breast cancer. Research published today in the open access journal BMC Cancer suggests that while staying positive has a protective role, adverse life events such as the loss of a parent or close relative, divorce or the loss of a spouse can increase a woman's risk of developing the disease.
Anti-tumor effects are enhanced by inhibiting 2 pathways rather than 1
Two independent research groups have found that simultaneous inhibition of two signaling pathways resulted in substantially enhanced antitumor effects in mouse models of prostate and breast cancer. In an accompany commentary, Steven Grant, at Virginia Commonwealth University Health Science Center, Richmond, discusses the clinical importance of these studies and highlights some of the questions that still need to be answered.
Why a common treatment for prostate cancer ultimately fails
Some of the drugs given to many men during their fight against prostate cancer can actually spur some cancer cells to grow, researchers have found. The findings were published online this week in a pair of papers in the Proceedings of the National Academy of Sciences.
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