Breast Cancer Screening Among Childhood Cancer Survivors Treated Without Chest Radiation: Clinical Benefits and Cost-Effectiveness
Menée à partir de données portant sur des patientes atteintes d'une leucémie ou d'un sarcome durant l'enfance mais n'ayant pas reçu de radiothérapie thoracique, cette étude évalue, à l'aide de modèles de simulation, le risque de décès par cancer du sein en l'absence d'examens de dépistage ainsi que l'intérêt, du point de vue du pourcentage de décès évités, d'un programme de dépistage annuel comportant une mammographie et une IRM chez les femmes âgées entre 25 et 40 ans, puis évalue le rapport coût-efficacité du programme de dépistage en fonction de l'âge minimal d'éligibilité
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 two Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer 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 (ICERs).
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 MRI screening between ages 25 and 40 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 was the only strategy with an ICER 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 may reduce breast cancer deaths by half and is cost-effective. These findings could help inform screening guidelines for survivors treated without chest radiation.
Journal of the National Cancer Institute , résumé, 2020