Cost-effectiveness of Screening BRCA 1 / 2 Mutation Carriers With Breast Magnetic Resonance Imaging

WOMEN WHO INHERIT DELeterious mutations in the BRCA1 or BRCA2 cancer susceptibility genes have a 45% to 65% lifetime risk of developing breast cancer. The risk can be reduced by prophylactic mastectomy but many BRCA1/2 mutation carriers decline prophylactic mastectomy and seek effective screening strategies that detect breast cancer early. Current screening guidelines recommend annual mammography starting at age 25 years despite the low sensitivity of mammography in this population. Screening with contrastenhanced breast magnetic resonance imaging (MRI) has been shown to detect disease earlier than mammography in high-risk women; cancers detected by MRI are often axillary lymphnode negative and stage I. Recently, the Blue Cross and Blue Shield Technology Evaluation Center reported that screening with breast MRI provides clinical benefit to high-risk women. Although breast MRI screening is highly sensitive, it increases the rate of falsepositive test results, and it has not been shown to reduce breast cancer mortality. Furthermore, breast MRI screening is at least 10 times more expensive than mammographic screening and generates higher diagnostic costs. Because cost may be the greatest barrier to broader evaluation and dissemination of breast MRI screening, its costeffectiveness is a critical consideration. We evaluated the cost-effectiveness of addingbreastMRIscreening in BRCA1/2 mutation carriers, incorporating the