While breast cancer is something that affects tons of people it is also something that can be quite controversial. Could screenings be causing more harm than good in some cases?
A study published in the journal JAMA Oncology just days ago shows that in women who are at a lower risk of breast cancer getting screened at all might not be a good idea. Researchers looked at individualized screening protocols and then the risks for each woman of developing the condition itself. In this, they were able to determine that not offering mammograms to women at low risk could effectively reduce the harm associated with screenings.
All the while it would also not substantially increase the number of cases that are missed. For the most part, it would be beneficial to our health and cost-effective. While most people might think it would be better to just get screened perhaps a self-exam might be a better option unless you find something you are concerned about.
The abstract of this study goes as follows:
Importance The age-based or “one-size-fits-all” breast screening approach does not take into account the individual variation in risk. Mammography screening reduces death from breast cancer at the cost of overdiagnosis. Identifying risk-stratified screening strategies with a more favorable ratio of overdiagnoses to breast cancer deaths prevented would improve the quality of life of women and save resources.
Objective To assess the benefit-to-harm ratio and the cost-effectiveness of risk-stratified breast screening programs compared with a standard age-based screening program and no screening.
Design, Setting, and Population A life-table model was created of a hypothetical cohort of 364 500 women in the United Kingdom, aged 50 years, with follow-up to age 85 years, using (1) findings of the Independent UK Panel on Breast Cancer Screening and (2) risk distribution based on polygenic risk profile. The analysis was undertaken from the National Health Service perspective.
Interventions The modeled interventions were (1) no screening, (2) age-based screening (mammography screening every 3 years from age 50 to 69 years), and (3) risk-stratified screening (a proportion of women aged 50 years with a risk score greater than a threshold risk were offered screening every 3 years until age 69 years) considering each percentile of the risk distribution. All analyses took place between July 2016 and September 2017.
Main Outcomes and Measures Overdiagnoses, breast cancer deaths averted, quality-adjusted-life-years (QALYs) gained, costs in British pounds, and net monetary benefit (NMB). Probabilistic sensitivity analyses were used to assess uncertainty around parameter estimates. Future costs and benefits were discounted at 3.5% per year.
Results The risk-stratified analysis of this life-table model included a hypothetical cohort of 364 500 women followed up from age 50 to 85 years. As the risk threshold was lowered, the incremental cost of the program increased linearly, compared with no screening, with no additional QALYs gained below the 35th percentile risk threshold. Of the 3 screening scenarios, the risk-stratified scenario with risk threshold at the 70th percentile had the highest NMB, at a willingness to pay of £20 000 (US $26 800) per QALY gained, with a 72% probability of being cost-effective. Compared with age-based screening, risk-stratified screening at the 32nd percentile vs 70th percentile risk threshold would cost £20 066 (US $26 888) vs £537 985 (US $720 900) less, would have 26.7% vs 71.4% fewer overdiagnoses, and would avert 2.9% vs 9.6% fewer breast cancer deaths, respectively.
Conclusions and Relevance Not offering breast cancer screening to women at lower risk could improve the cost-effectiveness of the screening program, reduce overdiagnosis, and maintain the benefits of screening.
These findings are quite interesting when you really consider how damaging mammograms can be. They expose you to radiation, aren’t always accurate, and are not as easy to read in those who would be considered low risk anyway. What do you think about all of this?