Breast Cancer Screening Value is Questioned

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SAN FRANCISCO—For women aged 50 and older who are on dialysis, routine mammography screening for breast cancer may not be a cost-effective use of medical resources, according to an Australian study.

 

“Given the available data, at best, routine breast cancer screening in this population with a significantly reduced overall survival does not appear good value for money,” the researchers concluded.

 

A team led by Germaine Wong, MD, who is with the National Health and Medical Research Council Centre for Clinical Research Excellence in Renal Medicine in Sydney, used a technique called Markov decision analytical modeling to weigh the benefits and costs of breast cancer screening in two hypothetical groups of women.

 

All the women were aged 50 to 69 and on dialysis. One group underwent mammography and one did not. The mathematical simulation used research data from the Australian and New Zealand Data Registry (ANZDATA) on breast cancer rates among women on dialysis, along with expected survival rates and mortality rates.

 

The cost of once-yearly mammograms, including the costs of diagnosing and treating detected breast cancers, averaged about $4,300 per patient per year (in Australian dollars). The simulation also suggested that yearly mammograms would prevent just one breast cancer death per 1,000 dialysis patients screened. The model estimated that, for each year of life saved, screening would add $154,783 to the total costs of care. By comparison, the average costs of mammography for each year of life saved in the general population range from $20,000 to $40,000.

 

According to the researchers, several factors affected the costs and benefits of screening, including the rate of breast cancer, the accuracy of mammography, stage at which the cancer was diagnosed, and effectiveness of breast cancer treatment. However, even using the most favorable assumptions, breast cancer screening for dialysis patients was unlikely to be cost-effective, the investigators found.

 

Currently, regular screening mammograms are recommended for most women aged 50 to 69. How-ever, because patients with end-stage renal disease (ESRD) are at increased risk of death due to kidney disease and other medical problems such as heart disease, it has been unclear whether the costs of routine breast cancer screening are justified for women on dialysis. “Cancer screening is important because the overall cancer risk increases in renal transplant recipients and in patients on dialysis,” Dr. Wong said. “Treatment options for cancers in these populations are limited because of coexisting illnesses.”

 

“In contrast to most other cancers, the risk of breast cancer in the dialysis population is almost identical to that of the general popu-lation, but data on the effectiveness of screening for breast cancers in women on dialysis is relatively sparse thus far,” Dr. Wong said. “Even though the patients have the same risk, we are unsure whether women on dialysis would achieve the same benefits as patients in the general population.”
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