Risk-based breast cancer screening may reduce costs, overdiagnosis


Not offering breast cancer screening to low-risk women and implementing risk-stratified breast screening programs may improve the cost-effectiveness of screening programs and reduce over diagnosis, according to research published July 5 in JAMA Oncology.

The study, led by Nora Pashayan, MD, PhD, from the department of applied health research at the University College of London, examined how age-based breast cancer screenings can reduce death from while limiting overdiagnosis. 

"Identifying risk-stratified screening strategies with a more favorable ratio of over diagnoses to breast cancer deaths prevented would improve the quality of life of women and save resources," Pashayan et al. wrote. "Risk-stratified screening would require assessing risk of all women, which would entail additional costs, however these may be offset by eliminating repeated screening of women at lower risk and avoiding treatment of over diagnosed cancers." 

To evaluate the cost effectiveness and benefit-to-harm ratio of risk-stratified breast screening compared with standard age-based breast screening and no screening at all, Pashayan and colleagues created a "life-table model" of a hypothetical cohort that included 364,500 women in the U.K. aged 50 to 85 years old with follow-up at one year. 

Overall, they found that targeting screening to women at a higher risk of breast cancer was associated with both reduced rates of overdiagnosis and limited cost of screening.  Targeting also maintained reduced breast cancer deaths, the researchers wrote. 

"The optimal risk threshold for risk-stratified screening depends on the acceptable trade-off between improving cost-effectiveness and maximizing benefits and minimizing harms of screening," the researchers wrote. "Not offering screening to women in the lower tertile of the risk distribution would improve the cost-effectiveness of the breast screening program, reduce over diagnosis while maintaining the benefits of screening. Robust data are needed to evaluate fully risk-tailored screening." 

In terms of implementing a risk-stratified screening programs, one example is tailoring screening modality, frequency and start and stop age to an individual's risk level, as well as other approaches, however challenges such as ensuring a genetic testing for screening eligibility, ensuring equitable access and having regulatory approvals must be considered in the process, the researchers advised.