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Autor/a:
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Vilaprinyo Terré, Ester; Forné Izquierdo, Carles; Carles Lavila, Misericordia; Sala i Serra, Maria; Pla Farnós, Roger; Castells, Xavier; Domingo, Laia; Rué i Monné, Montserrat; Interval Cancer Study Group
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Notas:
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The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The
present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening
strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of
cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and
input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the
benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low,
moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of
breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and
quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups.
Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based
strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher
than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is
characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the
high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual
risk and to work on how to implement risk-based screening strategies.
This study was funded by grants PS09/01340 and PS09/01153 from the Health Research Fund (Fondo de Investigación Sanitaria) of the Spanish Ministry of Health. The authors thank the Breast Cancer Surveillance Consortium and the funding that the BCSC received from the National Cancer Institute (U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040, and HHSN261201100031C). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. |
