Cost-effective mammography screening in Korea: High incidence of breast cancer in young women

ObjectivesArgentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country’s Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare.MethodsA cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results.ResultsIt was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations.DiscussionTele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic.ConclusionThere is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.

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Environmental Exposures during Puberty: Window of Breast Cancer Risk and Epigenetic Damage

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020493 ◽

2020 ◽

Vol 17 (2) ◽

pp. 493 ◽

Cited By ~ 6

Author(s):

Rama Natarajan ◽

Dana Aljaber ◽

Dawn Au ◽

Christine Thai ◽

Angelica Sanchez ◽

...

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Young Women ◽

Food Additives ◽

Environmental Exposures ◽

Cost Effective ◽

Environmental Damage ◽

Environmental Carcinogens ◽

Molecular Damage

During puberty, a woman’s breasts are vulnerable to environmental damage (“window of vulnerability”). Early exposure to environmental carcinogens, endocrine disruptors, and unhealthy foods (refined sugar, processed fats, food additives) are hypothesized to promote molecular damage that increases breast cancer risk. However, prospective human studies are difficult to perform and effective interventions to prevent these early exposures are lacking. It is difficult to prevent environmental exposures during puberty. Specifically, young women are repeatedly exposed to media messaging that promotes unhealthy foods. Young women living in disadvantaged neighborhoods experience additional challenges including a lack of access to healthy food and exposure to contaminated air, water, and soil. The purpose of this review is to gather information on potential exposures during puberty. In future directions, this information will be used to help elementary/middle-school girls to identify and quantitate environmental exposures and develop cost-effective strategies to reduce exposures.

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The challenge of evaluating annual mammography screening for young women with a family history of breast cancer

Journal of Medical Screening ◽

10.1177/096914130601300404 ◽

2006 ◽

Vol 13 (4) ◽

pp. 177-182 ◽

Cited By ~ 13

Author(s):

◽

Rhian Gabe

Keyword(s):

Breast Cancer ◽

Family History ◽

Young Women ◽

Mammography Screening ◽

History Of

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Pendidikan Kesehatan tentang Deteksi Dini Kanker Payudara melalui Pemeriksaan Payudara Sendiri (SADARI)

Jurnal Abdimas Kesehatan (JAK) ◽

10.36565/jak.v3i2.162 ◽

2021 ◽

Vol 3 (2) ◽

pp. 115

Author(s):

Julaecha Julaecha

Keyword(s):

Breast Cancer ◽

Community Service ◽

Young Women ◽

Signs And Symptoms ◽

Reproductive Age ◽

Cure Rate ◽

Breast Self Examination ◽

Breast Examination ◽

High Incidence ◽

Self Examination

Breast cancer is one of the leading causes of death and many types of cancer occur in women. The incidence of breast cancer increases with age, however, young age is not a safe guarantee of breast cancer. The high incidence of breast cancer resulted in not a few sufferers of breast cancer that led to death. Signs and symptoms of breast cancer can be found as early as possible, the higher the cure rate. Breast self-examination (BSE) is one effective step if done as early as possible when women reach reproductive age. The purpose of community service is that teenagers consciously want to do breast self-examination routinely every month so as to reduce and reduce the risk of breast cancer. The method used by giving counseling and demonstration about BSE techniques to young women. An indicator of the success of this activity is that young women are able and able to conduct self-examination. Community service is carried out in Sungai Putri, Danau Sipin Sub-district, Jambi City on December 2018 - January 2019. The results of this activity are all young women understand and understand and can do their own breast examination (BSE).

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Germline and Tumor BRCA1/2 Pathogenic Variants in Chinese Triple-negative Breast Carcinomas

10.21203/rs.3.rs-262082/v1 ◽

2021 ◽

Author(s):

Gang Ji ◽

Longlong Bao ◽

Qianlan Yao ◽

Jing Zhang ◽

Xiaoli Zhu ◽

...

Keyword(s):

Breast Cancer ◽

Triple Negative ◽

Cost Effective ◽

Clinicopathological Characteristics ◽

Single Nucleotide ◽

Mutation Status ◽

Pathogenic Variants ◽

High Incidence ◽

Tumor Dna

Abstract PurposeThe cost-effectiveness of BRCA1/2 screening for all newly diagnosed breast cancer remains controversial with respect to standard treatment. Further evidences that include incidence and outcome of BRCA1/2 pathogenic variants (PV) screened based on age or family history (FH) are needed to fully justify this conclusion. We aimed to investigate germline and tumor BRCA1/2 PV based on age screening in Chinese triple-negative breast cancer (TNBC) patients. MethodsPaired blood and tumor DNA from 124 unselected Chinese TNBC patients with less than or equal to 55 years were collected and analyzed for BRCA1/2 PV. Clinicopathological characteristics including age at diagnosis, FH and follow-up data were collected for further analysis. ResultsThe entire frequency of germline and tumor BRCA1/2 PV was 21.0% and 25%, respectively. Among them, 20 (16.1%) germline and 5 (4.0%) somatic BRCA1/2 single-nucleotide variant/insertion/deletions were found by NGS testing, 6 (4.8%) BRCA1 large genomic rearrangements were detected in blood DNA by MPLA. There was significant correlation between FH and germline BRCA1/2 PV among these patients. Patients with tumor BRCA1/2 mutations had significant improvements than non-carriers in PFS ( p =0.047). No significant impacts were found between various mutation status in OS outcomes. No significant differences were found between BRCA1 or BRCA2 and non-carriers in PFS or OS. ConclusionThere is a high incidence of germline and tumor BRCA1/2 PVs in Chinese TNBC patients with less than or equal to 55 years old. Tumor BRCA1/2 PV carriers showed an improved survival outcome. Our results suggest that BRCA1/2 PVs testing addressed within each specific clinical scenario could be more cost-effective for patients.

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Cost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.6060 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 6060-6060 ◽

Cited By ~ 1

Author(s):

S. G. Moore ◽

J. Tumeh ◽

C. R. Flowers

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

High Risk ◽

Breast Cancer Screening ◽

Young Women ◽

Breast Mri ◽

Cost Effective ◽

Net Benefit ◽

The Cost

6060 Background: Breast magnetic resonance imaging (MRI) is a sensitive method of breast imaging virtually uninfluenced by breast density. Because of the improved sensitivity, breast MRI is increasingly being used for detection of breast cancer among high risk young women. However, the specificity of breast MRI is variable and costs are high. The purpose of this study was to determine if breast MRI is a cost-effective approach for the detection of breast cancer among young women at high risk. Methods: A Markov model was created to compare annual breast cancer screening over 25 years with either breast MRI or mammography among young women at high risk. Data from published studies provided probabilities for the model including sensitivity and specificity of each screening strategy. Costs were based on Medicare reimbursement rates for hospital and physician services while medication costs were obtained from the Federal Supply Scale. Utilities from the literature were applied to each health outcome in the model including a disutility for the temporary health state following breast biopsy for a false positive test result. The analysis was performed from the payer perspective with results reported in 2005 U.S. dollars. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters. Results: Breast MRI provided 23.287 quality-adjusted life-years (QALYs) at a cost of $30,317 while mammography provided 23.141 QALYs at a cost of $7,895 over 25 years of screening. The cost-effectiveness ratios for the two strategies were $1302 and $341, respectively. The incremental cost-effectiveness ratio of breast MRI compared to mammography was $131,376/QALY. In univariate analysis, breast MRI screening became <$50,000/QALY when the cost of the MRI was <$405. In the probabilistic sensitivity analysis, MRI screening produced a net benefit of +0.146 QALYs (95% central range: -0.825 QALYs to +1.378 QALYs). However, breast MRI screening was superior in <1%, <$50,000/QALY in 27%, >$50,000/QALY in 32%, and inferior in 41% of 10,000 probabilistic Monte Carlo simulations. Conclusions: Breast MRI provides a net benefit when compared to mammographic screening for high risk women, however, this approach does not appear to be cost-effective at this time. No significant financial relationships to disclose.

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