Survivors of childhood cancer treated with chest radiation at an increased risk for breast cancer

Survivors of childhood cancer who were treated with chest radiation may be at an increased risk for breast cancer. Children’s Oncology Group (COG) guidelines recommend annual mammography with breast magnetic resonance imaging (MRI), but the benefits and costs of these screenings are uncertain. A modeling study presented at the 2019 ASCO Annual Meeting found that screening at-risk survivors reduces mortality and is cost-effective.

 Researchers used two breast cancer simulation models from the Cancer Intervention and Surveillance Modeling Network and data from the Childhood Cancer Survivor Study to reflect high breast cancer and competing mortality risks among survivors. They simulated three screening strategies: annual mammography with MRI starting at 25 years of age (COG25), annual MRI starting at 25 years of age (MRI25), and biennial mammography starting at 50 years of age (Mammo50). Costs and quality of life weights were based on U.S. averages and published studies.

 Among a simulated cohort of 25-year-old survivors treated with chest radiation, the lifetime breast cancer mortality risk in the absence of screening was 10% to 11% across the models. Compared with no screening, Mammo50, MRI25, and COG25 screening strategies averted approximately 23% to 25%, 56% to 62%, and 56% to 71% of deaths, respectively. See TABLE for all outcomes for each of the two models.

The authors concluded that initiating annual screening at a younger age among at-risk survivors could prevent more than 50% of breast cancer-related deaths. “Additional data on test performance are needed to inform recommendations on screening modality,” they concluded.

	Model 1
Strategy	False-positive tests*	Incremental costs*†	QALYs gained*†	ICER
Mammo50	259	–	–	–
No screening	0	1,033,840	-74.4	‡
MRI25	3,283	5,629,340	285.3	$19,730
COG25	4,188	8,439,630	350.5	$43,100

 

	Model 2
Strategy	False-positive tests*	Incremental costs*†	QALYs gained*†	ICER
Mammo50	257	–	–	–
No screening	0	$839,750	-65.4	‡
MRI25	3,764	6,651,870	175.4	$37,920
COG25	4,879	9,463,560	171.6	‡

*Per 1,000 †Discounted ‡Dominated QALYs = quality-adjusted life-years; ICER = incremental cost-effectiveness ratio

 

Reference

Yeh J, Lowry KP, Schechter CB, et al. Clinical outcomes and cost-effectiveness of breast cancer screening for childhood cancer survivors treated with chest radiation: A comparative modeling study. Abstract #6525. Presented at the 2019 ASCO Annual Meeting, Chicago, IL, June 1, 2019.