Cost-effectiveness of Breast MRI Screening by Cancer Risk
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Introduction: Breast magnetic resonance imaging (MRI) is increasingly used as a screening tool for the early diagnosis of breast cancer. Although breast MRI has been shown in some settings to detect cancers when they are smaller, and potentially more curable, than mammography alone, MRI is more costly than mammography and can lead to a high rate of unnecessary breast biopsies, causing patients anxiety and discomfort. Screening breast MRI is likely to be of greatest benefit (measured as a ratio of its cost to its effectiveness) in women at increased risk of breast cancer for whom mammography performs poorly: women with dense breast tissue on mammography and women with high inherited breast cancer risk, particularly women in both of these groups who have other risk-increasing characteristics.
 
 
 
 
 
 
 
 Hypotheses: The goal of this project is to identify cost-effective protocols involving the addition of screening MRI to mammography for early breast cancer detection. The most cost-effective screening protocol will be the one which saves the greatest number of years of life (accounting, using women's preferences, for quality of life) at the lowest cost (in side-effects and in dollars) to screened women and to society. We will focus on women with dense breast tissue and women with high inherited breast cancer risk, and evaluate the impact of factors which increase (such as prior abnormal breast biopsy or hormone replacement therapy) and reduce (such as anti-hormonal medications or surgical removal of the ovaries) breast cancer risk on the cost-effectiveness of breast MRI screening. Depending on a woman's risk level and age, we will determine her most cost-effective breast MRI screening schedule (for example, yearly or every 2 years). 
 
 
 
 
 
 
 
 Methodology: We will modify a computer simulation model of mammographic screening, which generates breast cancer outcomes for individual women, and presents their aggregated results on a population level. This model, which was developed and validated by our research group, will be adapted to include the cancer detection ability of MRI, and the characteristics of women with dense breast tissue and women with high inherited breast cancer risk, including the impact of risk-modifying factors. The model will be modified using data from previous literature and from cancer registries. The preferences and experiences of high-risk women about breast MRI screening and its alternatives will be collected using survey instruments, and incorporated into the model. It will be used to calculate the estimated mortality reduction of screening MRI, its cost-effectiveness, and its optimal schedule according to a woman's age and breast cancer risk level. 
 
 
 
 
 
 
 
 Innovative elements: The question of how best to use screening breast MRI would be answered with a randomized clinical trial, which could determine whether screening MRI leads to reduced mortality through early breast cancer detection, but such a trial is ethically questionable given evidence of MRI's ability to find cancer early in some clinical settings. This project is innovative in its use of a computer simulation model to address the questions of mortality benefit, cost-effectiveness, and the optimal schedule of screening breast MRI, which are not likely to be answered otherwise in a timely fashion. Moreover, it is innovative in the inclusion of detailed information about breast cancer risk levels and women's measured preferences about MRI screening and its alternatives; this will result in a highly practical guide as to which women will most benefit from breast MRI, in terms of their survival and their quality of life.
 
 
 
 
 
 
 
 Advocacy involvement: This research aims to address the key human issue of how best to use a costly technology that has been shown to improve breast cancer detection, and promises to reduce mortality, among the many women who are not well served by standard mammographic methods of breast cancer screening. It aims to ensure that women at increased risk of breast cancer are significantly included in this project by using a survey instrument to measure their preferences regarding breast MRI screening and its alternatives, and by presenting results which incorporate those measured preferences. The design of this research project has benefited from the advice and involvement of Ms. Sue Friedman, founder and executive director of the breast cancer advocacy group FORCE (Facing Our Risk of Breast Cancer Empowered), whose letter of support is attached; her participation and that of other breast cancer advocates will be encouraged throughout the completion of this work.