Cost-Effectiveness of Magnetic Resonance Imaging Screening for Women With Extremely Dense Breast Tissue

Published on Nov 2, 2021in Journal of the National Cancer Institute13.506
· DOI :10.1093/JNCI/DJAB119
H. Amarens Geuzinge1
Estimated H-index: 1
(EUR: Erasmus University Rotterdam),
Marije F. Bakker21
Estimated H-index: 21
(UU: Utrecht University)
+ 10 AuthorsEvelyn M. Monninkhof54
Estimated H-index: 54
(UU: Utrecht University)
Sources
Abstract
Background null Extremely dense breast tissue is associated with increased breast cancer risk and limited sensitivity of mammography. The DENSE trial showed that additional magnetic resonance imaging (MRI) screening in women with extremely dense breasts resulted in a substantial reduction in interval cancers. The cost-effectiveness of MRI screening for these women is unknown. null Methods null We used the MISCAN-breast microsimulation model to simulate several screening protocols containing mammography and/or MRI to estimate long-term effects and costs. The model was calibrated using results of the DENSE trial and adjusted to incorporate decreases in breast density with increasing age. Screening strategies varied in the number of MRIs and mammograms offered to women ages 50-75 years. Outcomes were numbers of breast cancers, life-years, quality-adjusted life-years (QALYs), breast cancer deaths, and overdiagnosis. Incremental cost-effectiveness ratios (ICERs) were calculated (3% discounting), with a willingness-to-pay threshold of €22 000. null Results null Calibration resulted in a conservative fit of the model regarding MRI detection. Both strategies of the DENSE trial were dominated (biennial mammography; biennial mammography plus MRI). MRI alone every 4 years was cost-effective with €15 620 per QALY. Screening every 3 years with MRI alone resulted in an incremental cost-effectiveness ratio of €37 181 per QALY. All strategies with mammography and/or a 2-year interval were dominated because other strategies resulted in more additional QALYs per additional euro. Alternating mammography and MRI every 2 years was close to the efficiency frontier. null Conclusions null MRI screening is cost-effective for women with extremely dense breasts, when applied at a 4-year interval. For a willingness to pay more than €22 000 per QALY gained, MRI at a 3-year interval is cost-effective as well.
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References29
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#1Matthias F. Froelich (Heidelberg University)H-Index: 7
#2Clemens G. Kaiser (Heidelberg University)H-Index: 7
OBJECTIVES To evaluate the economic implications of our previous study on the use of MR-mammography (MRM) as a solitary imaging tool in women at intermediate risk due to dense breasts. BACKGROUND In our previous study, we found MRM to be a specific diagnostic tool with high accuracy in patients with dense breasts representing a patient collective at intermediate risk of breast cancer. For this study, we examined whether MRM is an economical alternative. METHODS For the determination of outcomes ...
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#1H Amarens Geuzinge (Erasmus University Medical Center)H-Index: 2
#2Inge-Marie Obdeijn (Erasmus University Medical Center)H-Index: 7
Last. Harry J. de Koning (Erasmus University Medical Center)H-Index: 28
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Importance For women with a 20% or more familial risk of breast cancer without a knownBRCA1/2(BRCA1, OMIM113705; andBRCA2, OMIM114480) orTP53(OMIM151623) variant, screening guidelines vary substantially, and cost-effectiveness analyses are scarce. Objective To assess the cost-effectiveness of magnetic resonance imaging (MRI) screening strategies for women with a 20% or more familial risk for breast cancer without a knownBRCA1/2orTP53variant. Design, Setting, and Participants In this economic eva...
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#1Erik VerburgH-Index: 3
#2Carla H. van Gils (Oklahoma State University Center for Health Sciences)H-Index: 9
Last. Kenneth G. A. GilhuijsH-Index: 39
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OBJECTIVES: To reduce the number of false-positive diagnoses in the screening of women with extremely dense breasts using magnetic resonance imaging (MRI), we aimed to predict which BI-RADS 3 and BI-RADS 4 lesions are benign. For this purpose, we use computer-aided diagnosis (CAD) based on multiparametric assessment. MATERIALS AND METHODS: Consecutive data were used from the first screening round of the DENSE (Dense Tissue and Early Breast Neoplasm Screening) trial. In this trial, asymptomatic w...
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#1Marije F. BakkerH-Index: 21
#2Stéphanie V. de Lange (ICL: Imperial College London)H-Index: 2
Last. Carla H. van GilsH-Index: 73
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Abstract Background Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonan...
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#1Kristien Keymeulen (Maastricht University Medical Centre)H-Index: 16
#2S. M. E. Geurts (Maastricht University Medical Centre)H-Index: 2
Last. VC Tjan-Heijnen (Maastricht University Medical Centre)H-Index: 5
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Background Determinants of the use of breast MRI in patients with ductal carcinoma in situ (DCIS) in the Netherlands were studied, and whether using MRI influenced the rates of positive resection margins and mastectomies. Methods All women aged less than 75 years, and diagnosed with DCIS between 2011 and 2015, were identified from the Netherlands Cancer Registry. Multivariable logistic regression analyses were performed, adjusting for incidence year, age, hospital type, DCIS grade and multifocal...
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#1Marta RománH-Index: 10
#2Maria SalaH-Index: 36
Last. Xavier BargallóH-Index: 11
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Abstract Background The effect of changes in mammographic density over time on the risk of breast cancer remains inconclusive. Methods We used information from four centres of the Breast Cancer Screening Program in Spain in the period 1996–2015. We analysed individual level data from 117,388 women first screened age 50–54, with at least two screening examinations. Breast density was determined using the BI-RADS classification (A to D in increasing order) at earliest and latest screening examinat...
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#1Johanna O. P. Wanders (UU: Utrecht University)H-Index: 8
#2Katharina Holland (Radboud University Nijmegen)H-Index: 8
Last. Nico Karssemeijer (Radboud University Nijmegen)H-Index: 68
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Purpose To determine to what extent automatically measured volumetric mammographic density influences screening performance when using digital mammography (DM).
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#1Marc B. I. LobbesH-Index: 32
#2Ingeborg J.H. Vriens (UM: Maastricht University)H-Index: 7
Last. Vivianne C. G. Tjan-Heijnen (UM: Maastricht University)H-Index: 58
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Purpose In this retrospective population-based cohort study, we analyzed breast MRI use and its impact on type of surgery, surgical margin involvement, and the diagnosis of contralateral breast cancer.
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#1Valérie D.V. Sankatsing (EUR: Erasmus University Rotterdam)H-Index: 5
#2Eveline A.M. Heijnsdijk (EUR: Erasmus University Rotterdam)H-Index: 30
Last. Harry J. de Koning (EUR: Erasmus University Rotterdam)H-Index: 84
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In the Netherlands, routine mammography screening starts at age 50. This starting age may have to be reconsidered because of the increasing breast cancer incidence among women aged 40 to 49 and the recent implementation of digital mammography. We assessed the cost-effectiveness of digital mammography screening that starts between age 40 and 49, using a microsimulation model. Women were screened before age 50, in addition to the current programme (biennial 50-74). Screening strategies varied in s...
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#1Marleen J. EmausH-Index: 9
#2Marije F. BakkerH-Index: 21
Last. Carla H. van GilsH-Index: 73
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The Dense Tissue and Early Breast Neoplasm Screening, or DENSE, trial is a randomized multicenter trial to evaluate supplementary MR imaging screening in women with extremely dense breasts that is aimed at detecting a reduction in interval cancers as a proxy of breast cancer mortality.
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