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Using Risk Stratification to Optimize Mammography Screening in Chinese Women

BACKGROUND: The cost-effectiveness of mammography screening among Chinese women remains contentious. Here, we characterized breast cancer (BC) epidemiology in Hong Kong and evaluated the cost-effectiveness of personalized risk-based screening. METHODS: We used the Hong Kong Breast Cancer Study (a ca...

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Autores principales: Leung, Kathy, Wu, Joseph T, Wong, Irene Oi-ling, Shu, Xiao-Ou, Zheng, Wei, Wen, Wanqing, Khoo, Ui-Soon, Ngan, Roger, Kwong, Ava, Leung, Gabriel M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346705/
https://www.ncbi.nlm.nih.gov/pubmed/34377936
http://dx.doi.org/10.1093/jncics/pkab060
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author Leung, Kathy
Wu, Joseph T
Wong, Irene Oi-ling
Shu, Xiao-Ou
Zheng, Wei
Wen, Wanqing
Khoo, Ui-Soon
Ngan, Roger
Kwong, Ava
Leung, Gabriel M
author_facet Leung, Kathy
Wu, Joseph T
Wong, Irene Oi-ling
Shu, Xiao-Ou
Zheng, Wei
Wen, Wanqing
Khoo, Ui-Soon
Ngan, Roger
Kwong, Ava
Leung, Gabriel M
author_sort Leung, Kathy
collection PubMed
description BACKGROUND: The cost-effectiveness of mammography screening among Chinese women remains contentious. Here, we characterized breast cancer (BC) epidemiology in Hong Kong and evaluated the cost-effectiveness of personalized risk-based screening. METHODS: We used the Hong Kong Breast Cancer Study (a case-control study with 3501 cases and 3610 controls) and Hong Kong Cancer Registry to develop a risk stratification model based on well-documented risk factors. We used the Shanghai Breast Cancer Study to validate the model. We considered risk-based programs with different screening age ranges and risk thresholds under which women were eligible to join if their remaining BC risk at the starting age exceeded the threshold. RESULTS: The lifetime risk (15-99 years) of BC ranged from 1.8% to 26.6% with a mean of 6.8%. Biennial screening was most cost-effective when the starting age was 44 years, and screening from age 44 to 69 years would reduce breast cancer mortality by 25.4% (95% credible interval [CrI] = 20.5%-29.4%) for all risk strata. If the risk threshold for this screening program was 8.4% (the average remaining BC risk among US women at their recommended starting age of 50 years), the coverage was 25.8%, and the incremental cost-effectiveness ratio (ICER) was US$18 151 (95% CrI = $10 408-$27 663) per quality-of-life-year (QALY) compared with no screening. The ICER of universal screening was $34 953 (95% CrI = $22 820-$50 268) and $48 303 (95% CrI = $32 210-$68 000) per QALY compared with no screening and risk-based screening with 8.4% threshold, respectively. CONCLUSION: Organized BC screening in Chinese women should commence as risk-based programs. Outcome data (e.g., QALY loss because of false-positive mammograms) should be systemically collected for optimizing the risk threshold.
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spelling pubmed-83467052021-08-09 Using Risk Stratification to Optimize Mammography Screening in Chinese Women Leung, Kathy Wu, Joseph T Wong, Irene Oi-ling Shu, Xiao-Ou Zheng, Wei Wen, Wanqing Khoo, Ui-Soon Ngan, Roger Kwong, Ava Leung, Gabriel M JNCI Cancer Spectr Article BACKGROUND: The cost-effectiveness of mammography screening among Chinese women remains contentious. Here, we characterized breast cancer (BC) epidemiology in Hong Kong and evaluated the cost-effectiveness of personalized risk-based screening. METHODS: We used the Hong Kong Breast Cancer Study (a case-control study with 3501 cases and 3610 controls) and Hong Kong Cancer Registry to develop a risk stratification model based on well-documented risk factors. We used the Shanghai Breast Cancer Study to validate the model. We considered risk-based programs with different screening age ranges and risk thresholds under which women were eligible to join if their remaining BC risk at the starting age exceeded the threshold. RESULTS: The lifetime risk (15-99 years) of BC ranged from 1.8% to 26.6% with a mean of 6.8%. Biennial screening was most cost-effective when the starting age was 44 years, and screening from age 44 to 69 years would reduce breast cancer mortality by 25.4% (95% credible interval [CrI] = 20.5%-29.4%) for all risk strata. If the risk threshold for this screening program was 8.4% (the average remaining BC risk among US women at their recommended starting age of 50 years), the coverage was 25.8%, and the incremental cost-effectiveness ratio (ICER) was US$18 151 (95% CrI = $10 408-$27 663) per quality-of-life-year (QALY) compared with no screening. The ICER of universal screening was $34 953 (95% CrI = $22 820-$50 268) and $48 303 (95% CrI = $32 210-$68 000) per QALY compared with no screening and risk-based screening with 8.4% threshold, respectively. CONCLUSION: Organized BC screening in Chinese women should commence as risk-based programs. Outcome data (e.g., QALY loss because of false-positive mammograms) should be systemically collected for optimizing the risk threshold. Oxford University Press 2021-06-07 /pmc/articles/PMC8346705/ /pubmed/34377936 http://dx.doi.org/10.1093/jncics/pkab060 Text en © The Author(s) 2021. Published by Oxford University Press. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Article
Leung, Kathy
Wu, Joseph T
Wong, Irene Oi-ling
Shu, Xiao-Ou
Zheng, Wei
Wen, Wanqing
Khoo, Ui-Soon
Ngan, Roger
Kwong, Ava
Leung, Gabriel M
Using Risk Stratification to Optimize Mammography Screening in Chinese Women
title Using Risk Stratification to Optimize Mammography Screening in Chinese Women
title_full Using Risk Stratification to Optimize Mammography Screening in Chinese Women
title_fullStr Using Risk Stratification to Optimize Mammography Screening in Chinese Women
title_full_unstemmed Using Risk Stratification to Optimize Mammography Screening in Chinese Women
title_short Using Risk Stratification to Optimize Mammography Screening in Chinese Women
title_sort using risk stratification to optimize mammography screening in chinese women
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346705/
https://www.ncbi.nlm.nih.gov/pubmed/34377936
http://dx.doi.org/10.1093/jncics/pkab060
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