Personalized Approach to Mammography Most Cost-Effective, but at What Risk to Women?

August 2011, Vol 2, No 5 - Value Propositions


The most recent mammography screening recommendations call on women to begin annual screening for breast cancer at age 40 years, regardless of their risk for the disease. This “one-size-fits-all” approach, based on age alone, leads to too many screenings for some women and not enough for others, according to investigators of a recent cost-analysis (Schousboe JT, et al. Ann Intern Med. 2011;155:10-20).

With a cost-effectiveness threshold of $100,000 per quality-adjusted lifeyear (QALY), biennial mammography is most cost-effective for women aged 40 to 49 years, the researchers claim. With a cost per QALY of $340,000 for annual screening, the current strategy is not cost-effective, regardless of the woman’s age or breast density, these investigators say.

Nevertheless, clinicians take a different approach. The American Congress of Obstetricians and Gynecologists recently issued new screening guidelines recommending annual screening for all women aged 40 to 49 years, which was a reversal of its previous recommendation for biennial screening for that age-group.

And the American Society of Breast Disease (ASBD) has recently issued a statement expressing support for this strategy. According to the ASBD, recent evidence from several studies in Canada and Sweden shows that screening this younger women group can reduce deaths from breast cancer by 40% to 50%.

Younger women tend to have denser breasts and faster-growing tumors, so screening them is important, because the majority (>80%) of women with breast cancer have no known risk factors. The question of value in screening for breast cancer remains pertinent in the current economic situation, but when faced with the potential for life-threatening cancer, defining value is key to policy decisions.