"Abstract

Background:

Federally mandated breast density notifications motivate consideration of supplemental breast magnetic resonance imaging (MRI).

Objective:

To evaluate supplemental breast MRI strategies.

Design:

Simulation of women at average to 4 times higher-than-average relative risk (RR) for breast cancer incidence undergoing screening digital breast tomosynthesis (DBT) with or without supplemental MRI.

Data Sources:

Breast Cancer Surveillance Consortium and literature.

Target Population:

Women aged 40 years or older.

Time Horizon:

Lifetime.

Perspective:

U.S. federal payer.

Intervention:

Screening with DBT with or without breast density–targeted MRI by starting age (40, 45, or 50 years) and interval (annual or biennial).

Outcome Measures:

Breast cancer deaths averted, false-positive biopsy recommendations, harm–benefit ratios, and incremental cost-effectiveness ratios (ICERs).

Results of Base-Case Analysis:

Across all starting ages and intervals, DBT averted 7.4 to 10.5 breast cancer deaths per 1000 average-risk women screened and 23.2 to 33.6 per 1000 women with 4 times higher-than-average risk. Across all RR levels, DBT with supplemental MRI for women with extremely dense breasts (DBT+MRId) averted 0.1 to 0.8 additional breast cancer deaths and resulted in 22 to 186 additional false-positive biopsy recommendations. False-positive biopsies per breast cancer death averted for biennial DBT+MRId for women with 2 times higher-than-average risk were similar to those associated with DBT in average-risk women. For all risk groups, biennial DBT+MRId starting at age 50 years was more effective but less cost-effective than DBT starting at age 45 years.

Results of Sensitivity Analysis:

The ICERs were sensitive to cancer risk, MRI costs, and false-positive biopsy rates.

Limitation:

Subgroups considered risk and breast density only.

Conclusion:

Supplemental MRI for women aged 40 years or older with extremely dense breasts and higher-than-average risk (RR ≥2.0) had harm–benefit ratios similar to biennial DBT alone and could be cost-effective if MRI costs and false-positive biopsy rates are reduced.

Primary Funding Source:

National Cancer Institute."