Abstract B18: Personalizing the frequency of mammography: Cost effectiveness of screening mammography for women age 40 to 80 by breast density and other risk factors

Abstract

Abstract Background: Current guidelines recommend mammography starting at age 40 or 50 years regardless of individual risk of breast cancer and do not take into account a woman's risk of breast cancer or breast density. Methods: We used Markov microsimulation models to estimate the most cost-effectiveness intervals for screening mammography. Data about Breast Imaging Reporting and Data System (Bi-Rads) breast density, age, risk factors and risk of breast cancer, the natural history of breast cancer, estimates of progression in stages of breast cancer between mammograms, the cost of mammograms and medical care for breast cancer came from the Surveillance Epidemiology and End Results program, Breast Cancer Surveillance Consortium, and the medical literature. Simulations were done for cohorts receiving subsequent mammography between ages 40 to 79 years. We considered a strategy to be cost-effective if it cost ≤ $100,000 per lifetime quality adjusted life year (QALY) gained. Results: Between ages 50 to 79, mammography every 2 years is cost-effective (<$100,000 per QALY) for women with Bi-Rads-3 or −4 breast density, or with BI-RADS 1 or 2 and a family history of breast cancer or history of breast biopsy. Mammography is cost-effective if done less often -every 3 or 4 years — for women with lower (Bi-Rads-1 or −2) breast density and no family history of breast cancer or history of breast biopsy. For women age 40-49, mammography every 2 years is cost-effective for those with Bi-Rads-3 or −4 breast density plus a family history of breast cancer and/or a history of breast biopsy, but it is not cost-effective for 40 to 49 year olds without these risk factors and with lower breast density. In general, the most cost-effective screening interval is longer if false positive results cause a loss of quality of life. Conclusions: The frequency of mammography should be personalized based on woman's risk of breast cancer, estimated from her age, breast density, family history of breast cancer, history of breast biopsy and the potential effect of false positive mammograms on her quality of life. Citation Information: Cancer Prev Res 2010;3(12 Suppl):B18.