Aims
- To estimate the difference in breast cancer mortality in women under the age of 50 with a significant family history of breast cancer having regular mammography compared to those not being screened.
- To estimate the cost-effectiveness of regular mammography in this group of women, compared to no screening.
Summary
The identification of two highly penetrative breast cancer susceptibility genes attracted intense media interest. Unrealistic expectations of genetic testing and understanding about the relevance of family history have raised public and professional anxiety. Many women presenting with a family history of breast cancer under the age of 50 are offered mammograms as preliminary retrospective data suggest it is possible to identify impalpable breast cancer in this group with regular mammography. The effectiveness of this service, however, has not been formally evaluated.
We propose to perform such an evaluation in a cohort of 10,000 women under the age of 50 with a significant family history of breast cancer, given regular mammographic surveillance over five years. Comparison of surgical and pathological data with completed and on-going population screening trials using analysis techniques of varying complexity will be performed to obtain an accurate estimate of breast cancer mortality reduction.
The change in health service resource use attributable to mammography will be compared with no screening and costed. Incremental cost effectiveness ratios of implementing the standardised mammography strategy compared with no screening will be presented in terms of the additional cost per cancer detected, per life saved and per life year saved.