UC Davis

Background

Surveillance with annual mammography and breast magnetic resonance imaging (MRI) is recommended for female survivors of childhood cancer treated with chest radiation, yet benefits, harms, and costs are uncertain.

Objective

To compare the benefits, harms, and cost-effectiveness of breast cancer screening strategies in childhood cancer survivors.

Design

Collaborative simulation modeling using 2 Cancer Intervention and Surveillance Modeling Network breast cancer models.

Data sources

Childhood Cancer Survivor Study and published data.

Target population

Women aged 20 years with a history of chest radiotherapy.

Time horizon

Lifetime.

Perspective

Payer.

Intervention

Annual MRI with or without mammography, starting at age 25, 30, or 35 years.

Outcome measures

Breast cancer deaths averted, false-positive screening results, benign biopsy results, and incremental cost-effectiveness ratios (ICERs).

Results of base-case analysis

Lifetime breast cancer mortality risk without screening was 10% to 11% across models. Compared with no screening, starting at age 25 years, annual mammography with MRI averted the most deaths (56% to 71%) and annual MRI (without mammography) averted 56% to 62%. Both strategies had the most screening tests, false-positive screening results, and benign biopsy results. For an ICER threshold of less than $100 000 per quality-adjusted life-year gained, screening beginning at age 30 years was preferred.

Results of sensitivity analysis

Assuming lower screening performance, the benefit of adding mammography to MRI increased in both models, although the conclusions about preferred starting age remained unchanged.

Limitation

Elevated breast cancer risk was based on survivors diagnosed with childhood cancer between 1970 and 1986.

Conclusion

Early initiation (at ages 25 to 30 years) of annual breast cancer screening with MRI, with or without mammography, might reduce breast cancer mortality by half or more in survivors of childhood cancer.

Primary funding source

American Cancer Society and National Institutes of Health.