Modeling study finds benefit in personalized mammogram schedules

Personalized mammography schedules based on women's individual risk factors could be more beneficial and cost-effective than generalized recommendations, according to a new modeling study.

Researchers applied a Markov model to data from the Surveillance, Epidemiology and End Results program, the Breast Cancer Surveillance Consortium, and other reports from the medical literature. The study included U.S. women between ages 40 and 79 who had an initial mammogram at age 40 and breast density between 1 and 4, according to the Breast Imaging and Reporting Data System (BI-RADS) categories. The researchers calculated the cost per quality-adjusted life-year (QALY) gained from screening, and considered screening programs cost-effective if a QALY was gained for $100,000 or less.

Their findings confirmed current guidelines recommending biennial screening for most women between the ages of 50 to 74. However, for women in that age range with BI-RADS category 1 density, no previous breast biopsies and no family history, the model found that less frequent screening (every three to four years) may be more appropriate, based on cost-effectiveness and potential harms.

For younger women (between ages 40 and 49), the study supported individual screening strategies, based on the results of an initial mammogram at age 40. If that initial screening indicated a BI-RADS category of 1 or 2 and the woman had no other risk factors, mammography could be resumed at age 50, the authors said. For women with higher density and/or risk factors, biennial screening was cost-effective. Annual screening was not found to be cost-effective for any group, according to the model. These results do not apply to women who carry the BRCA1 or BRCA2 mutations, the study noted.

Based on the study's results, the authors concluded that mammogram recommendations should be personalized based on age, breast density, history of breast biopsy and family history of breast cancer. They suggested that BI-RADS categories be included in mammography reports to assist primary care physicians. The authors noted that their conclusions are projected from a national perspective (such as payers and guideline writers), and that individual women may also want to base their decisions on personal feelings about the benefits and harms of screening.

The potential of a personalized screening approach is exciting, but further research is needed and limitations remain, according to an accompanying editorial. Such an approach could be difficult to communicate, and the study's findings were based on film rather than digital mammography, the editorialists noted. The study and editorial appeared in the July 5 Annals of Internal Medicine.