MRI Useful, Cost-Effective for Women with a Family History of Breast Cancer

Magnetic resonance imaging can be helpful and cost-effective in detecting breast cancer in certain patient populations, according to new research presented at the 8th European Breast Cancer Conference in Vienna, Austria.

While the use of MRIs in detecting breast cancer has been proven to be cost-effective and helpful for women with BRCA1/2 gene mutations, research has been inconclusive as to the cost-effectiveness for women who do not have the mutations but who do have first and/or second degree relatives with breast cancer history. Since women with such a familial history have a 20% chance of developing breast cancer by the age of 70, Dr. Sepideh Saadatmand, Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues conducted a cost-effectiveness analysis using participants enrolled in the Dutch MRI Screening Study.

Participants (N= 1,597) received a clinical breast examination every 6 months and annual mammography and MRI. At follow-up (median=5 years), Saadatmand et al. found 38 invasive and 9 ductal carcinoma in situ breast cancers (none had metastasized). Based on this information, Saadatmand et al. calculated the cost per detected breast cancer. Cost for detecting breast cancer was lowest among women over the age of 60, with a mean total cost of €50,153. The researchers also found that the cost increased as age decreased, with the greatest cost in the group younger than 30 years old (that group had mean total cost of €275,446). However, Saadatmand and colleagues noted that the youngest patient population might benefit the most from MRI screening due to breast density.

“We found that it costs approximately three times as much to add MRI to the screening process for every estimated one year of life saved,” Saadatmand explained at the conference. “When women were screened using clinical breast examinations, mammography and MRI, the cost per detected cancer was about €103,000. We predicted that screening women between the ages of 35-60 in this way would reduce deaths from breast cancer by 24%, at a cost per year of life gained of €30,000.”

Saadatmand added, “The subgroups we expect to benefit from MRI screening are women with a cumulative lifetime risk above 20% due to their family history, who have very dense breast tissue. Breast density may strongly influence screening results, since it increases breast cancer incidence significantly and decreases the sensitivity of mammography, but not of MRI. Therefore, for women with high breast density, MRI might be cost-effective.”