8 INTERNATIONAL RESEARCH & OPINION

Breastcancerscreenrnng - more women, more often?

If the budget for the UK National Health Service (NHS) breast cancer screening programme would allow for 2 more screening invitations per woman, then either the screening frequency could be increased or the age range of women covered by the programme could be extended. So say Dr Rob Boer from Erasmus University, Rotterdam, The Netherlands, and collegues from Europe. 1

Under the current NHS breast cancer screening programme, women aged 50-64 years are invited to undergo breast cancer screening once every 3 years. However, Dr Boer and colleagues have predicted that, for the north west health region in England, extending the age range during which women can be invited to undergo breast cancer screening from 50-64 years to 50-69 years would reduce mortality by 16.4% at a marginal cost of £2990 per additional life-year gained [see table]. *

Costs and outcomes associated with 3 different screening strategies" for breast cancer

Current ExWnalonto lWo-~ aae69veera Int8rvIII

Reduction in mortally (%) 12.8 16.4 15.3

Total Rt.yaars gaIned"0 12251 15161 14987

Total costs' (£ million)" 30.9 39.6 40.6

COSt per me-year gained 2522 2611 2709 (£) ..

COSt per adcttional -IHe-year galned* (£) ..

2990 3545

° In the current programme, women aged 50-64 years are Invited to undergo breast cancer screening once f1Very 3 years. Alternatively, women aged 5G-69 years could be Invited to undergo breast cancer screening once fNefy 3 years, or women aged 50-64 years could be Invited to undergo breast cancer screMng once f1Very 2 years.

o. disrounted al a rate of 6% per year

t Total costs Included those related to screening, ~s, treatment, and foiIow.up.

* relative to the current orocnmme

They also estimated that increasing the frequency of breast cancer screening from once every 3 years to once every 2 years would reduce mortality by 15.3% at a marginal cost of £3545 per additional life-year gained.

These results were produced using a model based on modified data from 2 Dutch breast cancer screening trials.

Don't exclude elderly women Although a 1986 UK government report recognised

that older women were more likely to develop breast cancer, it was recommended that this population should not be routinely invited for screening because of low cost effectiveness due to a likely low uptake and shorter life expectancy.

However, the first-year results of a UK pilot study have shown that there is the potential for a high uptake rate and a high cancer detection among women aged 65-69 years who are routinely invited for breast cancer screening.2

PharmacoEconomics & 0utr:0m6s News 15 Aug 19118 No. 175

The overall uptake was 80% for women aged < 65 years, 76% for those aged 65-67 years, and 73% for those aged 68 or 69 years. The total cancer detection rate per 1000 women was 7.1, 8, and 17.4 in these 3 groups of women, respectively.

Ethical dilemma The choice between increasing the frequency of

breast cancer screening and increasing the age of last invitation to age 69 years presents healthcare policy­makers with an ethical dilemma, say Drs Ursula Werneke and Klim McPherson of the London School of Hygiene and Tropical Medicine, London, UK.3

It is therefore unfortunate that Dr Boer and colleagues did not model the effects of the combined implementation of both strategies, thereby providing an assessment of how necessary it really is to pursue only one of these 2 options, they note. * Costs and outcomes were discounted at a rate of6% per year.

1. Boer R, et al. Cost effecti veness of shortening screening interval or extending age range of NHS breast screening programme: computer simulation study. British Medical Journal 317: 376-379. 8 Aug 19982. Rubin G. et al. Routine invitation of women aged 65-69 for breast cancer screening: results of first year of pilot study. British Medical Journal 317: 388-389. 8 Aug 19983. Wemeke L;, et al. Extending the benefits of breast cancer screening. British Medical Journal 317: 360-36\, 8 Aug 1998 8006Jl107

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