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Article: Using Risk Stratification to Optimize Mammography Screening in Chinese Women
Title | Using Risk Stratification to Optimize Mammography Screening in Chinese Women |
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Authors | |
Issue Date | 2021 |
Publisher | Oxford University Press (OUP): Policy C - Option D. The Journal's web site is located at http://jnci.oxfordjournals.org/ |
Citation | JNCI Cancer Spectrum, 2021, v. 5 n. 4, article no. pkab060 How to Cite? |
Abstract | Background:
The cost-effectiveness of mammography screening among Chinese women remains contentious. Here, we characterized breast cancer (BC) epidemiology in Hong Kong and evaluated the cost-effectiveness of personalized risk-based screening.
Methods:
We used the Hong Kong Breast Cancer Study (a case-control study with 3501 cases and 3610 controls) and Hong Kong Cancer Registry to develop a risk stratification model based on well-documented risk factors. We used the Shanghai Breast Cancer Study to validate the model. We considered risk-based programs with different screening age ranges and risk thresholds under which women were eligible to join if their remaining BC risk at the starting age exceeded the threshold.
Results:
The lifetime risk (15-99 years) of BC ranged from 1.8% to 26.6% with a mean of 6.8%. Biennial screening was most cost-effective when the starting age was 44 years, and screening from age 44 to 69 years would reduce breast cancer mortality by 25.4% (95% credible interval [CrI] = 20.5%-29.4%) for all risk strata. If the risk threshold for this screening program was 8.4% (the average remaining BC risk among US women at their recommended starting age of 50 years), the coverage was 25.8%, and the incremental cost-effectiveness ratio (ICER) was US$18 151 (95% CrI = $10 408-$27 663) per quality-of-life-year (QALY) compared with no screening. The ICER of universal screening was $34 953 (95% CrI = $22 820-$50 268) and $48 303 (95% CrI = $32 210-$68 000) per QALY compared with no screening and risk-based screening with 8.4% threshold, respectively.
Conclusion:
Organized BC screening in Chinese women should commence as risk-based programs. Outcome data (e.g., QALY loss because of false-positive mammograms) should be systemically collected for optimizing the risk threshold. |
Persistent Identifier | http://hdl.handle.net/10722/300531 |
ISSN | |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Leung, K | - |
dc.contributor.author | Wu, JT | - |
dc.contributor.author | Wong, IOL | - |
dc.contributor.author | Shu, XO | - |
dc.contributor.author | Zheng, W | - |
dc.contributor.author | Wen, W | - |
dc.contributor.author | Khoo, US | - |
dc.contributor.author | Ngan, R | - |
dc.contributor.author | Kwong, A | - |
dc.contributor.author | Leung, GM | - |
dc.date.accessioned | 2021-06-18T14:53:17Z | - |
dc.date.available | 2021-06-18T14:53:17Z | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | JNCI Cancer Spectrum, 2021, v. 5 n. 4, article no. pkab060 | - |
dc.identifier.issn | 1475-4029 | - |
dc.identifier.uri | http://hdl.handle.net/10722/300531 | - |
dc.description.abstract | Background: The cost-effectiveness of mammography screening among Chinese women remains contentious. Here, we characterized breast cancer (BC) epidemiology in Hong Kong and evaluated the cost-effectiveness of personalized risk-based screening. Methods: We used the Hong Kong Breast Cancer Study (a case-control study with 3501 cases and 3610 controls) and Hong Kong Cancer Registry to develop a risk stratification model based on well-documented risk factors. We used the Shanghai Breast Cancer Study to validate the model. We considered risk-based programs with different screening age ranges and risk thresholds under which women were eligible to join if their remaining BC risk at the starting age exceeded the threshold. Results: The lifetime risk (15-99 years) of BC ranged from 1.8% to 26.6% with a mean of 6.8%. Biennial screening was most cost-effective when the starting age was 44 years, and screening from age 44 to 69 years would reduce breast cancer mortality by 25.4% (95% credible interval [CrI] = 20.5%-29.4%) for all risk strata. If the risk threshold for this screening program was 8.4% (the average remaining BC risk among US women at their recommended starting age of 50 years), the coverage was 25.8%, and the incremental cost-effectiveness ratio (ICER) was US$18 151 (95% CrI = $10 408-$27 663) per quality-of-life-year (QALY) compared with no screening. The ICER of universal screening was $34 953 (95% CrI = $22 820-$50 268) and $48 303 (95% CrI = $32 210-$68 000) per QALY compared with no screening and risk-based screening with 8.4% threshold, respectively. Conclusion: Organized BC screening in Chinese women should commence as risk-based programs. Outcome data (e.g., QALY loss because of false-positive mammograms) should be systemically collected for optimizing the risk threshold. | - |
dc.language | eng | - |
dc.publisher | Oxford University Press (OUP): Policy C - Option D. The Journal's web site is located at http://jnci.oxfordjournals.org/ | - |
dc.relation.ispartof | JNCI Cancer Spectrum | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.title | Using Risk Stratification to Optimize Mammography Screening in Chinese Women | - |
dc.type | Article | - |
dc.identifier.email | Leung, K: ksmleung@hku.hk | - |
dc.identifier.email | Wu, JT: joewu@hku.hk | - |
dc.identifier.email | Wong, IOL: iolwong@hku.hk | - |
dc.identifier.email | Khoo, US: uskhoo@hku.hk | - |
dc.identifier.email | Ngan, R: rkcngan@hku.hk | - |
dc.identifier.email | Kwong, A: avakwong@hku.hk | - |
dc.identifier.email | Leung, GM: gmleung@hku.hk | - |
dc.identifier.authority | Leung, K=rp02563 | - |
dc.identifier.authority | Wu, JT=rp00517 | - |
dc.identifier.authority | Wong, IOL=rp01806 | - |
dc.identifier.authority | Khoo, US=rp00362 | - |
dc.identifier.authority | Ngan, R=rp02371 | - |
dc.identifier.authority | Kwong, A=rp01734 | - |
dc.identifier.authority | Leung, GM=rp00460 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.1093/jncics/pkab060 | - |
dc.identifier.pmid | 34377936 | - |
dc.identifier.pmcid | PMC8346705 | - |
dc.identifier.hkuros | 322990 | - |
dc.identifier.volume | 5 | - |
dc.identifier.issue | 4 | - |
dc.identifier.spage | article no. pkab060 | - |
dc.identifier.epage | article no. pkab060 | - |
dc.identifier.isi | WOS:000744408900017 | - |
dc.publisher.place | United Kingdom | - |