Risk-Based Breast Cancer Screening versus Population-Based Breast Cancer Screening: A Review of the Comparative Clinical and Cost Effectiveness

Question

1. What is the comparative clinical effectiveness of risk-based breast cancer screening versus age-related population-based breast cancer screening?
2. What is the comparative cost effectiveness of risk-based breast cancer screening versus age-related population-based breast cancer screening?

Key Message

Data from one clinical study showed that population-based universal screening (biennial mammography on women 50 to 69 years of age) led to a higher breast cancer detection rate and lower mortality rate than risk-based screening did, when both strategies were compared to an annual clinical breast exam screening strategy. However, risk-based screening slightly reduced the over-diagnosis rate while universal screening significantly increased over-diagnosis rate compared to an annual clinical breast exam. One cost-effectiveness analysis from Spain showed that compared to the universal population-based strategies, risk-based screening resulted in a higher benefit for a specific cost, with reductions in costs, false-positive results and over-diagnosed cases, while it increased false-negative results. Findings were from a clinical trial with a short follow-up period for the outcome of mortality (10 years), and a single cost-effectiveness study from Spain, which may limit generalizability to the Canadian context.