A computer model simulation suggests that adding breast MRI screening may be cost-effective for women of certain ages who carry BRCA1 and BRCA2 gene mutations, according to a study in the May 24/31 issue of JAMA: The Journal of the American Medical Association.
Women who inherit mutations in the BRCA1 or BRCA2 cancer susceptibility genes have a 45 percent to 65 percent lifetime risk of developing breast cancer, according to background information in the article. The risk can be reduced by prophylactic mastectomy but many BRCA1/2 mutation carriers choose instead to seek effective screening strategies that detect breast cancer early. Screening with contrast-enhanced breast magnetic resonance imaging (MRI) has been shown to detect disease earlier than mammography in high-risk women; cancers detected by MRI are often axillary (near the armpit) lymph-node negative and stage I. Although breast MRI screening is highly sensitive, it increases the rate of false-positive test results, and it has not been shown to reduce the death rate from breast cancer. Additionally, breast MRI screening is at least 10 times more expensive than mammographic screening and generates higher diagnostic costs. Because cost may be the greatest barrier to broader evaluation and dissemination of breast MRI screening, its cost-effectiveness is a critical consideration.