MRI Screening for Breast Cancer Is Cost Effective for Some

Roxanne Nelson

March 23, 2012

March 23, 2012 — Screening with magnetic resonance imaging (MRI) can be beneficial in a subgroup of women with a family history of breast cancer. Even though it is very expensive, it could be cost effective for some women with a family history of the disease, even if they lack the BRCA1/2 gene mutation.

These new data were presented at the 8th European Breast Cancer Conference (EBCC-8), held in Vienna, Austria.

"MRI can often detect cancer earlier when added to a screening program, and has been considered cost effective for BRCA1/2 mutation carriers," said lead author Sepideh Saadatmand, MD, who is a PhD student at the Erasmus University Medical Center in Rotterdam, the Netherlands. However, "about 15% to 20% of women with breast cancer have a family history but no dominant gene mutation. These women are often screened annually with mammography," she said.

Although annual MRI screening has been found to be cost effective for women with a BRCA1/2 mutation, it remains unclear whether this is the case for women with a family history of breast cancer without a proven genetic predisposition, she explained during a press briefing held in advance of her presentation.

To address that issue, Dr. Saadatmand and colleagues conducted a cost-effectiveness analysis using participants enrolled in the Dutch MRI Screening Study from 1999 to 2007. The cohort of 1597 women had a total of 8370 woman-years at risk, and had an estimated cumulative lifetime risk of 15% to 50% of developing breast cancer. Participants were 25 to 70 years of age, and were screened with a clinical breast examination every 6 months and a mammography and MRI annually.

At a median follow-up of 5 years, 38 invasive and 9 ductal carcinoma in situ breast cancers were detected, but none had metastasized.

The researchers calculated the cost per detected breast cancer, which was incorporated into a microsimulation screening analysis model. The model can simulate programs with different screening modalities and time intervals, and takes overdiagnosis into account.

Cost of Screening

Age Group Number of Tumors Woman-Years at Risk Mean Total Cost (€)*
>60 y 4 321 50,153
50–60 y 15 1772 76,604
40–50 y 21 3167 96,991
30–40 y 7 2661 223,603
<30 y 0 455 275,446
Total 47 8370 111,215
*Includes screening, diagnosis, and treatment

"If we look at the age group above 60 years, we see that the costs are reasonable, at €50,000," explained Dr. Saadatmand. "But if we look at the 40-to 50-year age group, we see that the cost almost doubles. It doubles again in the 30- to 40-year category, which is probably due to a lower incidence of breast cancer in the younger age category."

Overall, the cost per detected cancer was about €103,380 for women screened using clinical breast examinations, mammography, and MRI. The researchers predicted that using these screening schemata, deaths from breast cancer would decrease in women 35 to 60 years by 24%, at a cost per life-year gained of €30,404.

If this population were screened only with annual mammography and clinical breast examination, the estimated reduction in deaths would be 20%, at a cost of €10,269 per life-year gained.

Dr. Saadatmand concluded that even though adding MRI to screening programs is expensive, especially in the youngest age categories, it is possible that it is most beneficial in this age group. "The reason for that is breast density," she pointed out. "High breast density is a risk factor for breast cancer, and it is also related to a decrease in the sensitivity of mammography."

Upcoming Trial

It is necessary to identify subgroups of women for whom MRI might be beneficial and cost effective, she explained. To do that, a randomized controlled trial is needed.

There is currently an a multicenter randomized controlled trial running in the Netherlands that is investigating this issue; it is expected to be completed in 2015. Dr. Saadatmand, who is involved in the study, explained that the cohort consists of women 30 to 55 years of age with a family history of breast cancer and a cumulative lifetime risk of developing the disease of more than 20%. The participants are randomized into 1 of 2 groups: annual screening with clinical breast examination and mammography; or annual screening with clinical breast examination and MRI and a biennial mammography.

The researchers will be evaluating the number of tumors detected at screening examinations, interval tumors, and cancer stage at diagnosis. Breast density will also be considered.

David Cameron, MD, MRCP, professor of oncology at the University of Edinburgh, United Kingdom, and chair of the EBCC-8, noted that this "study produces an estimate of the cost/benefit of additional MRI in screening high-risk women."

"It will inform the important ongoing debate about the role of MRI in screening, particularly for younger women who have a higher-than-average lifetime risk of developing breast cancer," he said in a statement.

8th European Breast Cancer Conference (EBCC-8): Abstract 27. Presented March 21, 2012.


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