Cost-Effectiveness of Risk Stratified Breast Cancer Screening

A study published in JAMA Oncology found that not offering breast cancer screening to women at lower risk could improve the cost-effectiveness of the screening program, reduce over-diagnosis, and maintain the benefits of screening. “The age-based or ‘one-size-fits-all’ breast screening approach does not take into account the individual variation in risk,” the researchers noted. 

Researchers used a life-table model of a hypothetical cohort of 364,500 U.K. women aged 50 years with follow-up to age 85 years, using findings of the Independent UK Panel on Breast Cancer Screening and risk distribution based on polygenic risk profile.  

The interventions included no screening, age-based screening (mammography screening every 3 years from 50 to 69 years), and risk-stratified screening (a proportion of women aged 50 years with a risk score greater than a threshold risk were offered screening every 3 years until 69 years). 

As the risk threshold lowered, the incremental cost of the program increased linearly compared with no screening, with no additional quality-adjusted life years (QALY) gained below 35th percentile risk threshold.  

In the risk-stratified cohort, the screening threshold at the 70th percentile had the highest net monetary benefit, at a willingness to pay of $26,800 per QALY gained, with a 72% probability of being cost-effective. Compared with age-based screening, risk-stratified screening at the 70th percentile risk threshold or less would cost $720,900 less over the study period and have 71.4% fewer over-diagnoses but would prevent 9.6% fewer breast cancer deaths. 

Source: JAMA Oncology