Supplemental Breast MRI for Women with Extremely Dense Breasts: Results of the Second Screening Round of the DENSE Trial

Veenhuizen, Stefanie G A; Lange, Stéphanie V de; Bakker, Marije F.; Pijnappel, Ruud M.; Mann, Ritse M.; Monninkhof, Evelyn M.; Emaus, Marleen J.; Koekkoek‐Doll, Petra K. de; Bisschops, Robertus H.C.; Lobbes, Marc; Jong, Mathijn de; Duvivier, Katya M.; Veltman, Jeroen; Karssemeijer, Nico; Koning, Harry J. de; Diest, Paul J. van; Mali, Willem P.Th.M.; Bosch, Maurice A.A.J. van den; Gils, Carla H. van; Veldhuis, Wouter B.

doi:10.1148/radiol.2021203633

Cited by 102 publications

(78 citation statements)

References 12 publications

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“…The new data by Veenhuizen et al. for the first time allow for a cost-effectiveness analysis addressing the diagnostic shifts between screening rounds ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…Recent data has hinted towards a role of MRM in an extended set of indications, such as screening women at intermediate risk of breast cancer due to their elevated density of breast tissue. The superior diagnostic performance of MRM compared to x-ray based techniques has been demonstrated in several prospective multicenter trials ( 3 – 5 ). Data on the first screening round of the DENSE trial indicated an incremental cost-effectiveness ratio (ICER) of two-yearly MRM screening below $ 10,000 per QALY gained as previously published in our model-based cost-effectiveness analysis ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…Most recently, Veenhuizen et al. closed this gap by delivering unprecedented data on the diagnostic performance of MRM in breast cancer screening beyond the first screening round ( 5 ). A reduced incremental cancer detection rate of 5.8 per 1000 screening examinations in the second screening round (respective 16.5 in the first screening interval) as well as an increased specificity of 97% for the second screening round (respective 92% in the first screening round) were observed in the second screening round of the DENSE trial.…”

Section: Introductionmentioning

confidence: 99%

“…A reduced incremental cancer detection rate of 5.8 per 1000 screening examinations in the second screening round (respective 16.5 in the first screening interval) as well as an increased specificity of 97% for the second screening round (respective 92% in the first screening round) were observed in the second screening round of the DENSE trial. All breast cancer cases were detected in an early stage (stage 0-1) and were node negative ( 5 ), underlining the diagnostic and prognostic potential of MRM, and hinting towards its economic value beyond the first screening interval.…”

Section: Introductionmentioning

confidence: 99%

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Cost-Effectiveness of MR-Mammography in Breast Cancer Screening of Women With Extremely Dense Breasts After Two Rounds of Screening

et al. 2021

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ObjectivesTo evaluate the cost-effectiveness of MR-mammography (MRM) vs. x-ray based mammography (XM) in two-yearly screening women of intermediate risk for breast cancer in the light of recent literature.MethodsDecision analysis and Markov modelling were used to compare cumulative costs (in US-$) and outcomes (in QALYs) of MRM vs. XM over the model runtime of 20 years. The perspective of the U.S. healthcare system was selected. Incremental cost-effectiveness ratios (ICER) were calculated and related to a willingness to pay-threshold of $ 100,000 per QALY in order to evaluate the cost-effectiveness. Deterministic and probabilistic sensitivity analyses were conducted to test the impact of variations of the input parameters. In particular, variations of the rate of false positive findings beyond the first screening round and their impact on cost-effectiveness were assessed.ResultsBreast cancer screening with MRM resulted in increased costs and superior effectiveness. Cumulative average costs of $ 6,081 per woman and cumulative effects of 15.12 QALYs were determined for MRM, whereas screening with XM resulted in costs of $ 5,810 and 15.10 QALYs, resulting in an ICER of $ 13,493 per QALY gained. When the specificity of MRM in the second and subsequent screening rounds was varied from 92% to 99%, the ICER resulted in a range from $ 38,849 to $ 5,062 per QALY.ConclusionsBased on most recent data on the diagnostic performance beyond the first screening round, MRM may remain the economically preferable alternative in screening women of intermediate risk for breast cancer due to their dense breast tissue.

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“…The new data by Veenhuizen et al. for the first time allow for a cost-effectiveness analysis addressing the diagnostic shifts between screening rounds ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cost-Effectiveness of MR-Mammography in Breast Cancer Screening of Women With Extremely Dense Breasts After Two Rounds of Screening

et al. 2021

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“…DCE-MRI has numerous indications in breast imaging and is widely used. DCE-MRI has excellent sensitivity, being the best available test for breast cancer detection (81–100%) [ 3 ], as well as good specificity, with pooled values around 70% [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. Yet there are overlapping characteristics between benign and malignant abnormalities in small lesions and among high-risk women, leading to unnecessary biopsies and causing patient anxiety [ 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Radiomics and Machine Learning with Multiparametric Breast MRI for Improved Diagnostic Accuracy in Breast Cancer Diagnosis

et al. 2021

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The purpose of this multicenter retrospective study was to evaluate radiomics analysis coupled with machine learning (ML) of dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI) radiomics models separately and combined as multiparametric MRI for improved breast cancer detection. Consecutive patients (Memorial Sloan Kettering Cancer Center, January 2018–March 2020; Medical University Vienna, from January 2011–August 2014) with a suspicious enhancing breast tumor on breast MRI categorized as BI-RADS 4 and who subsequently underwent image-guided biopsy were included. In 93 patients (mean age: 49 years ± 12 years; 100% women), there were 104 lesions (mean size: 22.8 mm; range: 7–99 mm), 46 malignant and 58 benign. Radiomics features were calculated. Subsequently, the five most significant features were fitted into multivariable modeling to produce a robust ML model for discriminating between benign and malignant lesions. A medium Gaussian support vector machine (SVM) model with five-fold cross validation was developed for each modality. A model based on DWI-extracted features achieved an AUC of 0.79 (95% CI: 0.70–0.88), whereas a model based on DCE-extracted features yielded an AUC of 0.83 (95% CI: 0.75–0.91). A multiparametric radiomics model combining DCE- and DWI-extracted features showed the best AUC (0.85; 95% CI: 0.77–0.92) and diagnostic accuracy (81.7%; 95% CI: 73.0–88.6). In conclusion, radiomics analysis coupled with ML of multiparametric MRI allows an improved evaluation of suspicious enhancing breast tumors recommended for biopsy on clinical breast MRI, facilitating accurate breast cancer diagnosis while reducing unnecessary benign breast biopsies.

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Collaborative Modeling to Compare Different Breast Cancer Screening Strategies

Trentham-Dietz,

Chapman,

Jayasekera

et al. 2024

JAMA

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ImportanceThe effects of breast cancer incidence changes and advances in screening and treatment on outcomes of different screening strategies are not well known.ObjectiveTo estimate outcomes of various mammography screening strategies.Design, Setting, and PopulationComparison of outcomes using 6 Cancer Intervention and Surveillance Modeling Network (CISNET) models and national data on breast cancer incidence, mammography performance, treatment effects, and other-cause mortality in US women without previous cancer diagnoses.ExposuresThirty-six screening strategies with varying start ages (40, 45, 50 years) and stop ages (74, 79 years) with digital mammography or digital breast tomosynthesis (DBT) annually, biennially, or a combination of intervals. Strategies were evaluated for all women and for Black women, assuming 100% screening adherence and “real-world” treatment.Main Outcomes and MeasuresEstimated lifetime benefits (breast cancer deaths averted, percent reduction in breast cancer mortality, life-years gained), harms (false-positive recalls, benign biopsies, overdiagnosis), and number of mammograms per 1000 women.ResultsBiennial screening with DBT starting at age 40, 45, or 50 years until age 74 years averted a median of 8.2, 7.5, or 6.7 breast cancer deaths per 1000 women screened, respectively, vs no screening. Biennial DBT screening at age 40 to 74 years (vs no screening) was associated with a 30.0% breast cancer mortality reduction, 1376 false-positive recalls, and 14 overdiagnosed cases per 1000 women screened. Digital mammography screening benefits were similar to those for DBT but had more false-positive recalls. Annual screening increased benefits but resulted in more false-positive recalls and overdiagnosed cases. Benefit-to-harm ratios of continuing screening until age 79 years were similar or superior to stopping at age 74. In all strategies, women with higher-than-average breast cancer risk, higher breast density, and lower comorbidity level experienced greater screening benefits than other groups. Annual screening of Black women from age 40 to 49 years with biennial screening thereafter reduced breast cancer mortality disparities while maintaining similar benefit-to-harm trade-offs as for all women.ConclusionsThis modeling analysis suggests that biennial mammography screening starting at age 40 years reduces breast cancer mortality and increases life-years gained per mammogram. More intensive screening for women with greater risk of breast cancer diagnosis or death can maintain similar benefit-to-harm trade-offs and reduce mortality disparities.

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Supplemental Breast MRI for Women with Extremely Dense Breasts: Results of the Second Screening Round of the DENSE Trial

Cited by 102 publications

References 12 publications

Cost-Effectiveness of MR-Mammography in Breast Cancer Screening of Women With Extremely Dense Breasts After Two Rounds of Screening

Cost-Effectiveness of MR-Mammography in Breast Cancer Screening of Women With Extremely Dense Breasts After Two Rounds of Screening

Radiomics and Machine Learning with Multiparametric Breast MRI for Improved Diagnostic Accuracy in Breast Cancer Diagnosis

Collaborative Modeling to Compare Different Breast Cancer Screening Strategies

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