Breast Cancer Screening Among Childhood Cancer Survivors Treated Without Chest Radiation: Clinical Benefits and Cost-Effectiveness
| Autor: | Jeanne S. Mandelblatt, Gregory T. Armstrong, Diana L. Miglioretti, Jennifer M. Yeh, Clyde B. Schechter, Melissa M. Hudson, Kathryn P. Lowry, Kevin C. Oeffinger, Lisa Diller, Paul C. Nathan, Amy Trentham-Dietz, Joseph P. Neglia, John M. Hampton, Natasha K. Stout, Qi Liu, Wendy M. Leisenring, Grace O’Brien, Oguzhan Alagoz, Chaya S. Moskowitz |
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| Rok vydání: | 2022 |
| Předmět: |
Oncology
Adult Cancer Research medicine.medical_specialty Pediatric Research Initiative Comparative Effectiveness Research Childhood leukemia Cost effectiveness Pediatric Cancer Cost-Benefit Analysis Clinical Trials and Supportive Activities Oncology and Carcinogenesis Breast Neoplasms Childhood Cancer Survivor Study Breast cancer screening Breast cancer Rare Diseases Quality of life Cancer Survivors Clinical Research Internal medicine Breast Cancer medicine Mammography Humans Mass Screening Oncology & Carcinogenesis Child Early Detection of Cancer Cancer Pediatric screening and diagnosis medicine.diagnostic_test business.industry Prevention Articles Health Services medicine.disease Detection Good Health and Well Being Cost Effectiveness Research Biomedical Imaging Female Sarcoma Quality-Adjusted Life Years business 4.2 Evaluation of markers and technologies |
| Zdroj: | Journal of the National Cancer Institute, vol 114, iss 2 J Natl Cancer Inst |
| Popis: | Background Early initiation of breast cancer screening is recommended for high-risk women, including survivors of childhood cancer treated with chest radiation. Recent studies suggest that female survivors of childhood leukemia or sarcoma treated without chest radiation are also at elevated early onset breast cancer risk. However, the potential clinical benefits and cost-effectiveness of early breast cancer screening among these women are uncertain. Methods Using data from the Childhood Cancer Survivor Study, we adapted 2 Cancer Intervention and Surveillance Modeling Network simulation models to reflect the elevated risks of breast cancer and competing mortality among leukemia and sarcoma survivors. Costs and utility weights were based on published studies and databases. Outcomes included breast cancer deaths averted, false-positive screening results, benign biopsies, and incremental cost-effectiveness ratios. Results In the absence of screening, the lifetime risk of dying from breast cancer among survivors was 6.8% to 7.0% across models. Early initiation of annual mammography with breast magnetic resonance imaging screening between ages 25 and 40 years would avert 52.6% to 64.3% of breast cancer deaths. When costs and quality-of-life impacts were considered, screening starting at age 40 years was the only strategy with an incremental cost-effectiveness ratio below the $100 000 per quality-adjusted life-year (QALY) gained cost-effectiveness threshold ($27 680 to $44 380 per QALY gained across models). Conclusions Among survivors of childhood leukemia or sarcoma, early initiation of breast cancer screening at age 40 years may reduce breast cancer deaths by half and is cost-effective. These findings could help inform screening guidelines for survivors treated without chest radiation. |
| Databáze: | OpenAIRE |
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