Adding breast MRI screening may be cost-effective for women of certain ages who carry BRCA1 and BRCA2 gene mutations, according to a study in the May issue of JAMA.
Women with the mutations have a 45 percent to 65 percent lifetime risk of developing breast cancer, background information in the article states.
Screening with contrast-enhanced breast MRI has been shown to detect disease earlier than mammography in high-risk women. However, breast MRI screening is at least 10 times more expensive than mammographic screening and generates higher diagnostic costs. Because cost may be the greatest barrier to wider use of breast MRI screening, its cost-effectiveness is an important consideration.
To better understand the pros and cons of breast MRI for high-risk women, researchers at Stanford 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 wrote.
The researchers believe that screening with MRI becomes more cost-effective as the breast cancer risk increases and mammography performance worsens, while greater quality of life gains accrue from MRI as 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," the authors wrote.