In order for organized screening programs to be justified in this time of economic constraints, overall benefits should outweigh harms at a reasonable cost. false positive results, overdiagnosis) in many of them –. Nevertheless, screening healthy women is expensive and may cause harms (e.g. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist.Įarly detection of breast cancer (BC) reduces mortality and may improve quality of life for most of the women diagnosed early by mammographic exams. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.įunding: This study was funded by grants PS09/01340 and PS09/01153 from the Health Research Fund (Fondo de Investigación Sanitaria) of the Spanish Ministry of Health. Received: ApAccepted: DecemPublished: February 3, 2014Ĭopyright: © 2014 Vilaprinyo et al. PLoS ONE 9(2):Įditor: Anna Sapino, University of Torino, Italy (2014) Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer.
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It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.Ĭitation: Vilaprinyo E, Forné C, Carles M, Sala M, Pla R, Castells X, et al. Risk-based strategies can reduce harm and costs. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach.
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