MRI Screening: A Cost-Effective Strategy for Women with Breast Cancer Family History

For women of a certain age who have a family history of breast cancer, MRI scans can be a cost-effective screening method, according to recently published research.

In a study published in JAMA Oncology, investigators from the Netherlands determined that using MRI to screen women ages 35 to 60 who have at least a 20-percent familial risk of breast cancer is a financially sound identification method. They recommended screening every 18 months.

The team, led by H. Amarens Geuzinge, MSc, from the department of public health at Erasmus University Medical Center in Rotterdam, reached their determinations by using a simulator that estimated the cost and lives saved across a population of 10 million Dutch women.

“This economic modeling study of data on Dutch women showed that the detection of more tumors at an early stage and fewer at a late stage by MRI could be a cost-effective method to reduce breast cancer mortality despite more over-diagnosis and higher costs in comparison with mammography,” Geuzinge wrote.

To make this determination, Geuzinge’s team used micro-simulation modeling with data gathered from February 2019 to May 2020. They concentrated on cost estimates from women who had the greater familiar risk without a known BRAC1, BRAC2, or TP53 genetic variant. The data came from women ages 25 to death.

Geuzinge’s team examined several screening protocols and various time intervals with women of a range of ages. Specifically, they looked at mammography protocols that included annual screening and clinical breast examinations, as well as MRI protocols that also include annual exams and clinical breast exams plus biennial mammography.

Based on those analyses, the team determined that MRI screening every 18 months would be the most cost-effective option, resulting in 79 additional quality-adjusted life years per 1,000 women. They did identify a greater drop in mortality with annual MRI screening, but the cost-effectiveness ratio was more than what the National Institutes for Health and Care Excellence guidelines permit.

Despite the greater cost-effectiveness associated with MRI screening every 18 months, implementing such a strategy could have disadvantages, Geuzinge’s team said. Not only is MRI a higher-cost exam, but additional screening could lead to more false positives and over-diagnosis. The higher patient volume could also present patient flow and management issues for clinical environments.

But, even with these potential drawbacks, the team recommended the industry have a larger conversation about modifying the existing screening guidelines, particularly focusing on abbreviated MRI which would offer the same diagnostic accuracy with shorter scan and reading times.