Cost-effectiveness of screening women with familial risk for breast cancer with magnetic resonance imaging

J Natl Cancer Inst. 2013 Sep 4;105(17):1314-21. doi: 10.1093/jnci/djt203. Epub 2013 Aug 12.


Background: To reduce mortality, women with a family history of breast cancer are often screened with mammography before age 50 years. Additional magnetic resonance imaging (MRI) improves sensitivity and is cost-effective for BRCA1/2 mutation carriers. However, for women with a family history without a proven mutation, cost-effectiveness is unclear.

Methods: We evaluated data of the largest prospective MRI screening study (MRISC). Between 1999 and 2007, 1597 women (8370 woman-years at risk) aged 25 to 70 years with an estimated cumulative lifetime risk of 15% to 50% for breast cancer were screened with clinical breast examination every 6 months and with annual mammography and MRI. We calculated the cost per detected and treated breast cancer. After incorporating MRISC data into a microsimulation screening analysis model (MISCAN), different schemes were evaluated, and cost per life-year gained (LYG) was estimated in comparison with the Dutch nationwide breast cancer screening program (biennial mammography from age 50 to 75 years). All statistical tests were two-sided.

Results: Forty-seven breast cancers (9 ductal carcinoma in situ) were detected. Screening with additional MRI costs $123 672 (€93 639) per detected breast cancer. In increasing age-cohorts, costs per detected and treated breast cancer decreased, but, unexpectedly, the percentage of MRI-only detected cancers increased. Screening under the MRISC-scheme from age 35 to 50 years was estimated to reduce breast cancer mortality by 25% at $134 932 (€102 164) per LYG (3.5% discounting) compared with 17% mortality reduction at $54 665 (€41 390) per LYG with mammography only.

Conclusions: Screening with MRI may improve survival for women with familial risk for breast cancer but is expensive, especially in the youngest age categories.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / economics*
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / genetics
  • Cost-Benefit Analysis
  • Early Detection of Cancer / economics*
  • Early Detection of Cancer / methods
  • Family
  • Female
  • Genes, BRCA1
  • Genes, BRCA2
  • Genetic Predisposition to Disease
  • Humans
  • Incidence
  • Magnetic Resonance Imaging / economics*
  • Mammography
  • Mass Screening / economics*
  • Mass Screening / methods
  • Medical History Taking
  • Middle Aged
  • Mutation
  • Netherlands / epidemiology
  • Palpation
  • Prospective Studies
  • Risk Assessment
  • Risk Factors