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Where money is tight, screening mammography is conditionally cost-effective compared with other proactive options In countries w...

Jul 19, 2022

Screening mammography seems a cost-effective means of minimizing the health and economic burdens of breast cancer in low- and middle-income countries ( LMICs ), according to a literature review published July 16 in the Journal of Global Health. However, most of the examined studies centered on countries at the upper end of the LMIC range, leaving the question of generalizability to poorer countries in need of a closer look. Ajeng Viska Icanervilia, MD, MPH, of the University of Groningen Medical Center in the Netherlands and colleagues focused on research that included detailed economic evaluations of screening mammography in LMICs. This led them to 21 qualified studies. Because technology-based proactive health measures such as screening mammography are inaccessible in parts of many LMICs, many communities rely on low-tech approaches. These might include clinical breast exams, risk factor assessments and/or point-of-care ultrasound, the authors note. Among the key findings of their review: The majority of studies deeming mammography screening a cost-effective approach vs. other strategies were conducted in upper middle-income countries (71%). Also: Eighteen of the 21 analyzed studies concluded screening mammography a cost-effective strategy, although some of these 18 did not did not assess mammography as a single screening strategy compared to no screening. Twelve of these 18 studies compared mammography screening only to no strategy or other strategy. Two studies compared the combination of mammography, risk-based assessment and ultrasound/clinical breast exam to no strategy or other strategy, while four studies compared mammography screening plus treatment of stage I-IV breast cancer to “other” strategy. Three-quarters of the included studies specified the screening interval. For most of these, the interval was two years, which was in general found to be cost-effective. When a comparison was made between biennial screening and annual or triennial screening, a biennial interval was found to be more cost-effective than the other screening interval strategies. The authors also note that, in several high-income countries, many women begin screening for breast cancer upon or soon after turning 40. The rub there is the “clear uncertainty about the magnitude of overdiagnosis among both younger and older women,” the authors point out. In some prior studies, they remark, early start age “reduced mortality more than at age 50, but it also consumed more resources and resulted in more false positives.” A Call for Breast Care Research in Lower-Income (and Lower-Middle-Income) Countries The authors conclude that screening mammography is, in general, a cost-effective strategy vs. other options for LMICs seeking to fight breast cancer at the population level. However, while screening mammography’s social and economic profitability is broadly evidenced in countries at or near the top of the LMIC socioeconomic ladder, “there is still limited evidence in the Lower MICs and lower-income countries, and the quality of studies varies widely,” the authors write. “Thus, more studies conducted in lower middle-income countries and lower-income countries are needed to better understand the cost-effectiveness of mammography screening in these regions.”

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