A 45 to 65 percent lifetime risk for developing breast cancer is associated with inheritance of the two breast cancer susceptibility genes, BRCA1 and BRCA2. Unfortunately, annual mammograms often miss breast cancer in women with dense breast tissue. Although magnetic resonance imaging (MRI) is more sensitive, it increases costs and the rate of false-positive results. Now research reports that annual MRI plus mammography is cost-effective for women at a high risk for breast cancer.
The study, published in The Journal of the American Medical Association, investigated the cost-effectiveness of screening BRCA1/2 gene carriers with mammography plus MRI, compared with mammography alone. Researchers at Stanford University School of Medicine in Stanford, California, designed a computer model of an imaginary group of women with mutations in their BRCA1 and/or BRCA2 genes. The data came from U.S. cancer databases and Medicare payments for 2005.
The computer model analyzed the cost-effectiveness of no screening, annual mammography from age 25-69 years, or annual mammography from ages 25-69 years plus annual MRI for specific age groups. The investigators assumed the women didn't have breast cancer before age 25, didn't have their breasts or ovaries removed, and didn't take medications to prevent breast cancer. The accuracy of mammography and MRI and the size of tumors each test could detect were also assumed.
The researchers found that annual breast MRI plus mammography was cost-effective for BRCA1/2 gene carriers aged 35 to 54 years. However, annual breast MRI plus mammography was not cost-effective for women younger than 35 or in women 55 and older.
"With substantial declines in its cost, breast MRI screening is likely to represent an acceptable value for a broader group of women," the study authors write. "Breast MRI screening is more cost-effective for BRCA1 than BRCA2 mutation carriers. The cost-effectiveness of adding MRI to mammography varies greatly by age."
REFERENCES:
1. Plevritis SK et al. Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging. JAMA 2006 May 24;295(20):2374-84.
Posted by Elaine Gavalas on August 16, 2006 01:46 PM
