Breast Cancer Screening Should Embrace Precision Medicine: Evidence by Reviewing Economic Evaluations in China

Abstract

The cost-effectiveness of conventional population-based breast cancer screening strategies (e.g. mammography) has been found controversial, while evidence shows that genetic testing for early detection of pathogenic variants is cost-effective. We aimed to review the economic evaluations of breast cancer screening in China to provide an information summary for future research on this topic. We searched the literature to identify the economic evaluations that examined breast cancer screening and testing in China, supplemented by hand-searching the reference lists of the included studies. We finally included five studies satisfying our inclusion criteria. Four articles examined mammography while the rest investigated multigene testing. The existing breast cancer screening programmes were found to be cost-effective among urban Chinese women, but one study concluded that they might cause harm to women in rural areas. Contextual factors, such as data absence, urban–rural disparity, willingness-to-pay threshold, and model design, imposed barriers to cost-effectiveness analysis. Multigene testing was found to be cost-effective and has a promising population impact among all women with breast cancer in China. Future research should investigate the cost-effectiveness of screening and identifying breast cancer through precision medicine technologies, including genetic testing, genome sequencing, cascade testing, and the return of secondary findings.

PTX3 promotes breast cancer cell proliferation and metastasis by regulating PKCζbreast cancer, pentraxin 3, protein kinase Cζ, proliferation, metastasis

“…Both the incidence of BC and deaths resulting from BC continue to rise, and its associated mortality is mainly due to disease progression or metastasis ( 27 ). The lack of early-stage diagnostic techniques and effective treatment methods continues to present major problems for the administration of BC therapy worldwide ( 28 ). Moreover, ~6-10% of newly diagnosed cases of BC are identified at stage IV of the disease, or the BC is already metastatic ( 27 ).…”

“…Previous studies have shown both that PTX3 is overexpressed in various tumors, and that it is involved in cancer progression through multiple signaling pathways ( 28 , 29 ). A recently published study ( 30 ) demonstrated that the transcription factor SOX9 directly regulates the expression of PTX3, whereas human leukocyte antigen system-associated genes are significantly upregulated when PTX3 is lacking in esophageal carcinoma (ESCA).…”

Prophylactic Interventions for Hereditary Breast and Ovarian Cancer Risks and Mortality in BRCA1/2 Carriers

“…Another issue regarding uptake rates is the predominant focus on evidence from developed nations. There is limited evidence from developing countries, where the guidelines for HBOC risk management, prophylactic strategies, genetic testing, and counselling are lacking [ 54 ]. The extrapolation of uptake parameters from developed to developing countries could lead to an inaccurate estimation of the cost effectiveness of interventions.…”

Establishing cost-effectiveness threshold in China: a community survey of willingness to pay for a healthy life year

“…In China, the National Healthcare Security Administration of China developed the national reimbursement drug list, where medications are listed depending on their effectiveness and cost-effectiveness, and reimbursed entirely or partly by the public health insurance schemes 21. GDP per capita-based CETs are often used to determine whether a medication is cost-effective 22–32. This approach has been adopted in the China guidelines for pharmacoeconomic evaluations 33.…”