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.
Although magnetic resonance imaging (MRI) 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 ten 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.
“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.”
MEDICA.de; Source: American Medical Association (AMA)