Evaluation Of Breast Cancer Screening Research Articles

SA54 A Scoping Review of Economic Evaluation of Breast Cancer Screening in China

The cost-effectiveness of conventional population-based breast cancer screening strategies (e.g., mammography) has been found controversial, while evidence shows that genetic testing for early detection of pathogenic variants is cost-effective.

Predictive Value of PI-RADS Is Low and Variable. Or Is It? Lessons We Can Learn from BI-RADS

HomeRadiology: Imaging CancerVol. 2, No. 6 PreviousNext Research HighlightsFree AccessPredictive Value of PI-RADS Is Low and Variable. Or Is It? Lessons We Can Learn from BI-RADSMateus TaveiraMateus TaveiraMateus TaveiraPublished Online:Nov 27 2020https://doi.org/10.1148/rycan.2020209033MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail Take-Away Points■ Major Focus: The Prostate Imaging Reporting and Data System (PI-RADS) classification system for prostate MRI established a standardized five-point scale for likelihood of clinically significant prostate cancer from 1 (very low) to 5 (very high). The true positive predictive value (PPV) of each PI-RADS category remains poorly validated.■ Key Result: In a retrospective cross-sectional study across 26 centers, PPV of PI-RADS ≥3 lesions (ie, intermediate to very high chance of malignancy) was 35% with large variability among centers and within a single center.■ Impact: PPV of PI-RADS classification system varies widely, but some centers have commendable precision and accuracy. Identifying factors contributing to high performance in some centers will improve global reproducibility and accreditation for prostate MRI.Because of adverse consequences of overdiagnosis and overtreatment of prostate cancer, imaging societies have developed standardized classification and reporting systems for prostate MRI (PI-RADS). PI-RADS version 2.1, updated in 2019, has been implemented worldwide. Despite single-center published data supporting the value of PI-RADS, concerns persist regarding its cross-center comparability and, more importantly, if the published performances could be replicated in community centers where most cancer screening occurs.Westphalen et al concluded that the PPV of PI-RADS was low and varied widely across centers. A historical comparison with BI-RADS, a much more mature reporting system for breast cancer screening, offers hope that the PPV of PI-RADS, even in the less accurate centers, is not that bad. Twenty-three years after initial publication of BI-RADS, an analysis by Salim et al showed that even among 24 high-volume readers, the PPV of an abnormal screening examination (BI-RADS categories 0, 4 or 5) was 8% and ranged from 4% to 14%. High-volume readers all had similar specificity (93%–99%), and variations in PPV arose from differences in reader sensitivity (53%–86%).The historical evolution of BI-RADS and breast cancer screening provides a path to make PI-RADS more accurate in a much shorter time frame. First, systematic biopsy of the prostate allows more opportunities to evaluate MRI findings against pathology samples, as compared with breast biopsy that only samples the suspicious area. Second, unlike mammograms, multiparametric MRI offers not only morphologic but also functional information, and MRI technologies for prostate MRI continue to advance more rapidly than mammography. Finally, the prostate cancer community can learn from BI-RADS strategies for audits and accreditation to kickstart the PI-RADS qualification process. Radiologists are not the only professionals involved in prostate cancer screening, but their involvement in the field through research, education, and quality control will be paramount for improving the lives of these patients while minimizing the risks of overdiagnosis and overtreatment.Highlighted ArticlesWestphalen AC, McCulloch CE, Anaokar JM, et al. Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: experience of the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel. Radiology 2020;296(1):76–84. doi:10.1148/radiol.2020190646Salim M, Dembrower K, Eklund M, Lindholm P, Strand F. Range of radiologist performance in a population-based screening cohort of 1 million digital mammography examinations Radiology 2020;297(1):33–39. doi:10.1148/radiol.2020192212Highlighted ArticlesWestphalen AC, McCulloch CE, Anaokar JM et al. Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: experience of the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel. Radiology 2020;296(1):76–84. doi:10.1148/radiol.2020190646 Link, Google ScholarSalim M, Dembrower K, Eklund M, Lindholm P, Strand F. Range of radiologist performance in a population-based screening cohort of 1 million digital mammography examinations Radiology 2020;297(1):33–39. doi:10.1148/radiol.2020192212 Link, Google ScholarArticle HistoryPublished online: Nov 27 2020 FiguresReferencesRelatedDetailsRecommended Articles Influence of Risk Category and Screening Round on the Performance of an MR Imaging and Mammography Screening Program in Carriers of the BRCA Mutation and Other Women at Increased RiskRadiology2017Volume: 286Issue: 2pp. 443-451ACR BI-RADS Assessment Category 4 Subdivisions in Diagnostic Mammography: Utilization and Outcomes in the National Mammography DatabaseRadiology2018Volume: 287Issue: 2pp. 416-422Additional Breast Cancer Detection at Digital Screening Mammography through Quality Assurance Sessions between Technologists and RadiologistsRadiology2020Volume: 294Issue: 3pp. 509-517Multicenter Evaluation of Breast Cancer Screening with Digital Breast Tomosynthesis in Combination with Synthetic versus Digital MammographyRadiology2020Volume: 297Issue: 3pp. 545-553Closing the Chapter on Supplemental Breast Cancer Screening with USRadiology2021Volume: 298Issue: 3pp. 576-577See More RSNA Education Exhibits Non-Contrast-Enhanced Breast MR Screening for Women with Dense BreastsDigital Posters2019The First 60 Days of COVID-19: A Mandatory Rapid and Unusual Distillation of Clinical Acuity of Breast Disease and Management ImplicationsDigital Posters2020BIRADS Mammography: What Do Residents Need to Know?Digital Posters2017 RSNA Case Collection Invasive Lobular CarcinomaRSNA Case Collection2021Invasive ductal carcinoma as developing asymmetryRSNA Case Collection2021Anterior transition zone prostate adenocarcinomaRSNA Case Collection2020 Vol. 2, No. 6 Metrics Downloaded 92 times Altmetric Score

Research on “Shared Health Care” Service Based on Queuing Model -- Optimization and Evaluation of Breast Cancer Screening of Primary Care

With the application of queuing theory model, this paper regards breast cancer screening in primary health care service center as a queuing system. With the help of the tide of sharing economy, it puts forward a joint screening scheme based on M/M/s model under shared mode, and compares it with M/M/1 model of non-shared mode, shortens patient waiting time by sharing medical resources, plans existing resources reasonably, and enhances the comprehensive strength of primary health care system so as to optimize the screening of breast cancer at the grass-roots level.

Epidemiological and economic evaluation of breast cancer screening in urban population in China: a multitarget calibrated modelling study

BackgroundBreast cancer is the most common cancer among women in China; however, a routine screening programme is currently not available. The aim of this study was to develop a novel model to estimate the effectiveness and cost-effectiveness of several screening strategies for women living in urban areas. MethodsWe developed a state-transition natural history model of breast cancer and validated the model with multiple outcomes for Chinese women living in urban areas. A total of 23 screening scenarios were considered with different screening techniques, ages, and frequencies. We evaluated the reduction of breast cancer mortality for each screening scenario compared with no screening. By integrating population-specific cost and utility scores, we calculated the incremental cost-effectiveness ratio (ICER) in terms of the cost per quality-adjusted life-year gained. FindingsIn the natural history model, the breast cancer incidence rate was estimated as 36·0 cases per 100 000 women and breast cancer mortality rate as 6·8 deaths per 100 000 women, which approximated reported rates from national cancer registries (incidence 34·9–36·5 cases per 100 000 women and 6·8–7·0 deaths per 100 000 women). Meanwhile, the modelled stage distribution and life expectancy were substantially similar to reported values. Compared with no screening, the breast cancer mortality of all screening scenarios decreased by 4·1–53·6%. The ICERs of 16 of the 23 scenarios was lower than the triple of the GDP per capita of China in 2018 (193 932 Chinese Yuan), indicating cost-effectiveness. At the national level, the biennial series-parallel strategy (ultrasound, followed by the mammography when suspected for women aged 40–44 years, and ultrasound combined with mammography for women aged 45–69 years) was the most cost-effective strategy, while the optimal screening interval differed with economic development at the provincial level. InterpretationWe developed a well calibrated natural history model of breast cancer for Chinese women living in urban areas. Generally, breast cancer screening is cost-effective in urban China. The biennial series-parallel strategy is recommended at the national level, but at the provincial level, the optimal strategy should be determined by balancing health gains and resources. FundingNational Natural Science Foundation of China (81773521 and 81402740) and National Health Commission of the People's Republic of China.

Estimation of health state utilities in breast cancer.

PurposeThe aim of this study is to determine the utility of breast cancer health states using the standard gamble (SG) and visual analog scale (VAS) methods in the Korean general population.Materials and methodsEight hypothetical breast cancer health states were developed based on patient education material and previous publications. Data from 509 individuals from the Korean general population were used to evaluate breast cancer health states using the VAS and the SG methods, which were obtained via computer-assisted personal interviews. Mean utility values were calculated for each human papillomavirus (HPV)-related health state.ResultsThe rank of health states was identical between two valuation methods. SG values were higher than VAS values in all health states. The utility values derived from SG were 0.801 (noninvasive breast cancer with mastectomy and followed by reconstruction), 0.790 (noninvasive breast cancer with mastectomy only), 0.779 (noninvasive breast cancer with breast-conserving surgery and radiation therapy), 0.731 (invasive breast cancer with surgery, radiation therapy, and/or chemotherapy), 0.610 (locally advanced breast cancer with radical mastectomy with radiation therapy), 0.587 (inoperable locally advanced breast cancer), 0.496 (loco-regional recurrent breast cancer), and 0.352 (metastatic breast cancer).ConclusionOur findings might be useful for economic evaluation of breast cancer screening and interventions in general populations.

Economic evaluation on breast cancer screening in mainland China: a systematic review

Objective: To gather available evidence related to the economic evaluation on breast cancer screening in mainland China and to provide reference for further research. Methods: A systematic review was conducted to identify articles in PubMed and three Chinese databases (CNKI, Wanfang and VIP) during 1995-2015. Data related to descriptive characteristics, rates on participation and detection for population-based studies, methods for model-based studies, types of economic evaluation and results, were extracted. A Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the reporting quality of included studies. Results: Of the 356 records searched in the databases, 13 studies (all published between 2012 and 2015) were included in the current paper involving 11 population-based studies and 3 model-based evaluations (1 study using both methods). Age of the participants who started to be engaged in the screening program ranged from 18 to 45 years old, but terminated at the age of 59 years or older. The screening modalities included single-used clinical breast examination, mammography and ultrasound or combined applications. Study persepectives were described in 7 studies, with 5 from the healthcare providers, and 2 from societal angles. Only 5 studies discounted cost or effectiveness. Out of 11 papers, 9 showed the results on cost-effectiveness analysis (CEA) that reporting the cost per breast cancer detection, with median as 145.0 thousand Chinese Yuan (CNY), ranging from 49.7 thousand to 2 293.0 thousand CNY. From 4 papers with results of cost-utility analysis (CUA), the cost per quality adjusted life year (QALY) gained or cost per disability adjusted life year (DALY) averted, were evaluated. The incremental cost-effectiveness ratio (ICER) was from 2.9 thousand to 270.7 thousand CNY (GDP per capita of China was CNY 49.3 thousand in 2015). In 13 studies, the quality of reporting varied, with an average score of 14.5 (range: 9.5-21.0). In the domains of study perspective, discounting, ICER and uncertainty, all the scores of equalities were relatively levels. Conclusions: Currently, evidence on economic evaluation of breast cancer screening in mainland China remained limited and weakly comparable, particularly model-based studies. Comprehensive analysis from societal perspective and QALY or DALY related cost-utility analysis should be implemented.

Cost-Effectiveness Analysis of Breast Cancer Screening in Rural Iran.

Although breast cancer is the most common cancer in women, economic evaluation of breast cancer screening is not fully addressed in developing countries. The main objective of the present study was to analyze the cost-effectiveness of breast cancer screening using mammography in 35-69 year old women in an Iranian setting. This was an economic evaluation study assessing the cost-effectiveness of a population-based screening program in 35-69 year old women residing in rural areas of South east Iran. The study was conducted from the perspective of policy-makers of insurance. The study population consisted of 35- to 69-year old women in rural areas of Kerman with a population of about 19,651 in 2013. The decision tree modeling and economic evaluation software were used for cost-effectiveness and sensitivity analyses of the interventions. The total cost of the screening program was 7,067.69 US$ and the total effectiveness for screening and no-screening interventions was 0.06171 and 0.00864 disability adjusted life years averted, respectively. The average cost-effectiveness ratio DALY averted US$ for screening intervention was 7,7082.5 US$ per DALY averted and 589,027 US $ for no-screening intervention. The incremental cost-effectiveness ratio DALY averted was 6,264 US$ per DALY averted for screening intervention compared with no-screening intervention. Although the screening intervention is more cost-effective than the alternative (no- screening) strategy, it seems that including breast cancer screening program in health insurance package may not be recommended as long as the target group has a low participation rate.

Age‐specific interval breast cancers in Japan: estimation of the proper sensitivity of screening using a population‐based cancer registry

The age-specific sensitivity of a screening program was investigated using a population-based cancer registry as a source of false-negative cancer cases. A population-based screening program for breast cancer was run using either clinical breast examinations (CBE) alone or mammography combined with CBE in the Miyagi Prefecture from 1997 to 2002. Interval cancers were newly identified by linking the screening records to the population-based cancer registry to estimate the number of false-negative cases of screening program. Among 112 071 women screened by mammography combined with CBE, the number of detected cancers, false-negative cases and the sensitivity were 289, 22 and 92.9%, respectively, based on the reports from participating municipalities. The number of newly found false-negative cases and corrected sensitivity when using the registry were 34 and 83.8%, respectively. In detected cancers, the sensitivity of screening by mammography combined with CBE in women ranging from 40 to 49 years of age based on a population-based cancer registry was much lower than that in women 50-59 and 60-69 years of age (40-49: 18, 71.4%, 50-59: 19, 85.8%, 60-69: 19, 87.2%). These data suggest that the accurate outcome of an evaluation of breast cancer screening must include the use of a population-based cancer registry for detecting false-negative cases. Screening by mammography combined with CBE may therefore not be sufficiently sensitive for women ranging from 40 to 49 years of age.

Bayesian evaluation of breast cancer screening using data from two studies.

The mean sojourn time (the duration of the period during which a cancer is symptom free but potentially detectable by screening) and the screening sensitivity (the probability that a screen applied to a cancer in the preclinical screen detectable period will result in a positive diagnosis) are two important features of a cancer screening programme. Little data from any single study are available on the potential effectiveness of mammographic screening for breast cancer in women with a family history of the disease, despite this being an important public health issue. We develop a method of estimation, from two separate studies, of the two parameters, assuming that transition from no disease to preclinical screen detectable disease, and from preclinical disease to clinical disease, are Poisson processes. Estimation is performed by a Markov chain Monte Carlo algorithm. The method is applied to the synthesis of two studies of mammographic screening in women with a family history of breast cancer, one in Manchester and one in Kopparberg, Sweden.

An evaluation of breast cancer screening in the South Thames (West) Region of the UK NHS Breast Screening Programme: the first 10 years

<h2>Abstract</h2> We have determined the progress of breast cancer screening in the South Thames (West) region of the UK National Health Service Breast Screening Programme (NHSBSP) from the start of screening in 1987 to 31 March 1997, by evaluating uptake, cancer detection rates, and interval cancer rates. Regional performance measures have been compared with NHSBSP targets. Uptake rates have been consistently close to the target of 70%, although marginally lower than the national average. Between 1 April 1990 and 31 March 1997 the region detected 1161 invasive cancers at prevalent (first) screen compared with a calculated age standardized expected number of 1164.2, a Standardised Detection Ratio (SDR) of 1.00 (95% Cl 0.94–1.06). During the same period, for incident (subsequent) screens, the region detected 640 invasive cancers compared with an expected 602.6, an SDR of 1.06 (95% Cl 0.98–1.15). The target SDR for both prevalent and incident screen is 1. The interval cancer rates over the period 1 April 1990 to 31 March 1994 for 0–23 months after a negative screen were 1.23 per 1000 (95% Cl 1.06–1.42) compared with a current national target of 1.20 per 1000. The evidence presented suggests that NHSBSP targets for both invasive cancer detection and interval cancer rates can be achieved.

Seventeen-year evaluation of breast cancer screening: the DOM project, The Netherlands. Diagnostisch Onderzoek (investigation) Mammacarcinoom.

The DOM project is a non-randomized population-based breast cancer screening programme in Utrecht which started in 1974-75. The 17-year effect has been evaluated by a case-control study of breast cancer deaths during the period 1975-92 in women living in the city of Utrecht, born between 1911 and 1925, whose breast cancers were diagnosed after the initiation of the DOM project. Controls (three for each case) were defined as women having the same year of birth as the case, living in the city of Utrecht at the time the case died, and having had the opportunity of screening in the DOM project. Screening in the period 1975-92 indicated a breast cancer mortality reduction of 46% (odds ratio of 0.54, 95% confidence interval 0.37-0.79). The strongest protective effect was found at a screening interval of 2 years or less (mortality reduction of 62%, odds ratio of 0.38), and for the highest number of screens (mortality reduction of 68%, odds ratio of 0.32 for more than four screens). Exclusion of breast cancer deaths that occurred within 1 year of diagnosis, to allow for 'lead-time' bias, gave an odds ratio of 0.61. Early diagnosis of breast cancer by screening reduces breast cancer mortality in the long term. Bias due to the study design may slightly overestimate the protective effect. A screening programme with a 2-yearly, or smaller, interval between successive screens will improve the protection of screening.

Cost evaluation of breast cancer screening in France

Cost evaluation of breast cancer screening in France

Optimisation of mammographic breast cancer screening using a computer simulation model

To optimise breast cancer screening protocols, risk (induction of fatal tumors) versus benefit (reduction in the number of fatal tumors) analyses are performed for a simulated stable Swedish female population, using the Model for evaluation of Breast cancer Screening (MBS). The present study comprises, the influences of various screening parameters, i.e. ages at which screening is started and stopped, interval period between successive sessions, tumor detection limits for screening and average glandular dose per screening session. When the results of the present study are expressed in terms of numbers of fatal breast tumors, it appears that starting and stopping ages for screening of 40 and 80 years, respectively, seem realistic. An increased screening frequency results in a larger reduction of breast cancer mortality. This reduction is significant for ages between 40 and 51 years but only marginal for ages above 70 years. High resolution screening, i.e., the detection of tumors at smaller size, results in a larger benefit but does not indicate a younger age for starting of screening. The average glandular dose per screening session does only influence the risks of screening. As separate risk and benefit results are presented, a change in average glandular dose on the total effect of screening can easily be calculated.

MBS: a model for risk benefit analysis of breast cancer screening.

Breast cancer screening programmes employing mammography are being implemented in various European countries. Different screening protocols are used in demonstration projects and nationwide programmes. To evaluate and improve protocols, a computer model for the evaluation of breast cancer screening has been developed. The availability of such a model can be of great importance in obtaining a better insight into the influence of various parameters. The Monte Carlo computer model is based on random selection from distributions of relevant parameters including tumour onset, tumour growth rate, lifetime expectancy, tumour detection size for screening and spontaneous observation. The radiation risk is calculated for various screening protocols employing multiplicative and additive risk models combined with lifetime expectancy, number of females screened and absorbed dose per screening session. The benefit is calculated on the basis of the reduction in tumour size at detection due to screening compared with spontaneous observation and the survival as a function of tumour diameter. Data from the Swedish two-county study are used to validate the model in terms of prevalence, interval tumour rates and interval tumour diameter distributions. Except for the spontaneous tumour diameter distribution, the model can describe the Swedish two-county study. Specific information is presented on the distributions of relevant parameters.

Cost‐effectiveness of mammographic screening in Australia

The purpose of this research was to estimate the cost-effectiveness of mammographic screening to supplement the results of the National Evaluation of Breast Cancer Screening which identified the mortality benefit as the most sensitive parameter. This appraisal used a different computer model, MISCAN, which models the effects of introducing a national screening program into a previously unscreened population, rather than basing estimates on the assumption of a fully established program. For the 40 to 49 age group a mortality reduction of 8 per cent was assumed, rather than the 30 per cent estimate utilised in the National Evaluation. The revised estimate is based on the two Swedish trials (Malmo and WE). New estimates for treatment costs were also incorporated into the MISCAN model. The cost-effectiveness of the policy recommended in the National Evaluation Report, $11,000 per life year saved with two-yearly screening of women over 40, is estimated by the MISCAN model to be $20,300. These differences arise partly from the difference in mortality effects for the 40 to 49 age group, but also from differences inherent in the steady-state and dynamic population approaches to modelling premature deaths averted. The MISCAN results confirm that screening for women over 50 is more cost-effective than screening women under 50. Screening all women aged 50 to 69 every two to three years is reasonable value for money. For women aged 40 to 49 the mortality benefit and cost-effectiveness is less clear, and it would be prudent to allow screening in this group until further evidence is available.