Advanced breast cancer and its prevention by screening

Hj, de Koning; Bm, van Ineveld; Jc, de Haes; Gj, van Oortmarssen; Jg, Klijn; Pj, van der Maas

doi:10.1038/bjc.1992.199

Cited by 54 publications

(26 citation statements)

References 23 publications

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“…37 An overview of all costs is shown in Table 1. 29, [37][38][39] Both the effects of screening and adjuvant treatment are simulated in MISCAN. In order to predict the effect of screening, breast cancer mortality is estimated for a scenario with adjuvant treatment and screening and compared to breast cancer mortality in a scenario with adjuvant therapy but without screening.…”

Section: Costs and Effectsmentioning

confidence: 99%

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Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Sankatsing

Heijnsdijk

Luijt

et al. 2015

Intl Journal of Cancer

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In the Netherlands, routine mammography screening starts at age 50. This starting age may have to be reconsidered because of the increasing breast cancer incidence among women aged 40 to 49 and the recent implementation of digital mammography. We assessed the cost-effectiveness of digital mammography screening that starts between age 40 and 49, using a microsimulation model. Women were screened before age 50, in addition to the current programme (biennial 50-74). Screening strategies varied in starting age (between 40 and 50) and frequency (annual or biennial). The numbers of breast cancers diagnosed, life-years gained (LYG) and breast cancer deaths averted were predicted and incremental cost-effectiveness ratios (ICERs) were calculated to compare screening scenarios. Biennial screening from age 50 to 74 (current strategy) was estimated to gain 157 life years per 1,000 women with lifelong follow-up, compared to a situation without screening, and cost e3,376/ LYG (3.5% discounted). Additional screening increased the number of LYG, compared to no screening, ranging from 168 to 242. The costs to generate one additional LYG (i.e., ICER), comparing a screening strategy to the less intensive alternative, were estimated at e5,329 (biennial 48-74 vs. current strategy), e7,628 (biennial 45-74 vs. biennial 48-74), e10,826 (biennial 40-74 vs. biennial 45-74) and e18,759 (annual 40-49 1 biennial 50-74 vs. biennial 40-74). Other strategies (49 1 biennial 50-74 and annual 45-49 1 biennial 50-74) resulted in less favourable ICERs. These findings show that extending the Dutch screening programme by screening between age 40 and 49 is cost-effective, particularly for biennial strategies.Breast cancer is the most commonly diagnosed form of cancer among women aged 30 and older in the Netherlands. 1 Mammography screening allows for early detection and early treatment of breast cancer, with the aim of averting breast cancer death. In the Netherlands, women aged 50 to 74 are invited biennially to screening. Various randomised controlled trials demonstrated a statistically significant breast cancer mortality reduction due to mammography screening in this age group. 2-4 Furthermore, Otto et al. 5,6 showed that the Dutch population-based screening programme is effective in reducing breast cancer mortality. The evidence for the benefit of mammography screening for younger women is less conclusive, 7-9 however, an effect for this age group is supported by several studies. Although the UK Age Trial showed a non-significant 17% reduction in breast cancer mortality, 9 a statistically significant breast cancer mortality reduction of 15% to 18% associated with screening for women aged 39 to 49 or 40 to 49 at entry was demonstrated by several meta-analyses of randomised controlled trials. [10][11][12][13] In addition, a recent Swedish observational study that compared breast cancer mortality rates between women aged 40 and 49 who were invited to screening and women who were not invited to screening demonstrated a 26% statistically significant br...

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Section: Costs and Effectsmentioning

confidence: 99%

“…6 Mean treatment costs per tumour stage. 7 Estimate from de Koning et al 1992 38 indexed to current price levels.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Sankatsing

Heijnsdijk

Luijt

et al. 2015

Intl Journal of Cancer

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“…Even more important would be to forecast changes for radiotherapy services, as investment in possible new machinery takes time. Considering both the increase in primary radiation treatment due to screening and the decreases in treatment for advanced disease (de Koning et al, 1992), the total number of radiotherapeutic sessions would increase by 5% in 1994, which is 22% of all sessions for breast cancer. This increase will initially have to be dealt with using existing facilities.…”

Section: Discussionmentioning

confidence: 99%

Changes in use of breast-conserving therapy in years 1978-2000

Koning

Dongen²,

Maas³

1994

Br J Cancer

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Summary The treatment of breast cancer patients has changed rapidly in the past decade, but empirical data at local and national level are scarce. Predicting the consequences of screening for primary treatment is consequently difficult. The aim of this analysis of records on admissions to hospital of women with breast cancer and/or for breast surgery together with a survey of all Dutch radiotherapy departments is to show the change in breast-conserving therapy and other primary treatment before the start of breast cancer screening in The Netherlands. There was a modest increase in breast-conserving therapy after 1981, coinciding with the first publication on its trial, followed by a sharp increase between 1985 and 1990, after the second publication. At the end of that 5 year period, 36% of all women with newly diagnosed invasive breast cancer underwent this type of surgery. Breast-conserving surgery is always followed by radiotherapy, but there has been a clear reduction in post-operative radiation after mastectomy. The percentage of breast-conserving therapy is at present higher in The Netherlands than in the USA. Implementing the Dutch screening programme will result in a maximum increase in breast-conserving therapy at national level of 34%, which stabilises at + 21%, or a 50% maximum increase at local level. The number of women treated by mastectomy will ultimately decrease by 9%. Given the rapidity of change towards the use of breast-conserving surgery, which is enhanced by screening, recent information will be needed in predicting capacity and assessing whether screen-detected women are treated adequately.The treatment of breast cancer patients has changed rapidly in the past decade. Several trials have led to a better understanding of the possible results of different types of primary treatment. Breast-conserving therapy, limited surgery followed by high-dose radiation, has been shown to be as effective as modified radical mastectomy for most operable patients (Veronesi et al., 1981). For mastectomy patients, routine post-operative radiotherapy is now usually considered unnecessary (Edland, 1988;Harris & Hellman, 1988). It could be assumed that treatment practice would be influenced by the information from these trials, but empirical data at national and local level are scarce in most countries (Farrow et al., 1992;Chouillet et al., 1994).At the same time, countries have started to implement breast cancer screening, as trials have shown that a reduction in mortality from breast cancer can be expected for screened women aged 50-69. The impact on the number and type of surgical procedures and radiotherapy will be great as a result of both the temporary increase in the number of women detected with breast cancer and the increase in early cancers (de Koning et al., 1990). Bottlenecks in capacity are expected, but there is a lack of empirical data to support this hypothesis.As we were especially uncertain about the development of breast-conserving therapy (outside a screening programme), we have analysed dat...

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“…For each time period, the estimated cost savigs apply. For the regimen outlined in (de Koning et al, 1992;Hurley et al, 1992;Richards et al, 1993 It must again be stressed that our estimates of cost savings are valid only within the confines of the model's assumptions and the data collected at Nottingham. It accordingly remains to be demonstrated more rigorously that the outcomes of serum marker assessment are at least as reliable as those of UICC and that our cost estimates are applicable to hospitals in general.…”

Section: Resmentioning

confidence: 93%

Potential for cost economies in guiding therapy in patients with metastatic breast cancer

Robertson

Whynes²,

Dixon³

et al. 1995

Br J Cancer

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Therapeutic response in patients with advanced breast cancer is conventionally assessed with reference to criteria devised by the International Union Against Cancer. Evidence to date suggests, however, that assessments of equivalent quality may be obtained at lower cost from the use of serum markers. The paper presents estimates of potential cost savings resulting from the use of serum markers in place of conventional assessment and argues that the size of these savings merits the establishment of a randomised controlled trial.

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Advanced breast cancer and its prevention by screening

Cited by 54 publications

References 23 publications

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Changes in use of breast-conserving therapy in years 1978-2000

Potential for cost economies in guiding therapy in patients with metastatic breast cancer

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