Cost-effectiveness of breast cancer screening using mammography in Vietnamese women

Cancer screening programs in South-east Asia and Western Pacific

BACKGROUND

The burden of cancer can be altered by screening. The field of cancer screening is constantly evolving; from the initiation of program for new cancer types as well as exploring innovative screening strategies (e.g. new screening tests). The aim of this study was to perform a landscape analysis of existing cancer screening programs in South-East Asia and the Western Pacific.

METHODS

We conducted an overview of cancer screening in the region with the goal of summarizing current designs of cancer screening programs. First, a selective narrative literature review was used as an exploration to identify countries with organized screening programs. Second, representatives of each country with an organized program were approached and asked to provide relevant information on the organizations of their national or regional cancer screening program.

RESULTS

There was wide variation in the screening strategies offered in the considered region with only eight programs identified as having an organized design. The majority of these programs did not meet all the essential criteria for being organized screening. The greatest variation was observed in the starting and stopping ages.

CONCLUSIONS

Essential criteria of organized screening are missed. Improving organization is crucial to ensure that the beneficial effects of screening are achieved in the long-term. It is strongly recommended to consider a regional cancer screening network.

Cost-benefit Analysis of Breast Cancer Screening with Digital Mammography: A Systematic Review

Background

Breast cancer is a non-communicable and common disease that accounts for a high percentage of deaths. Early diagnosis of this disease reduces the death rate. Screening methods such as digital mammography can help prevent or identify the disease earlier. Therefore, this study aims to analyze the cost-benefit of breast cancer using digital mammography.

Methods

This systematic review was conducted based on PRISMA 2020 checklist. PubMed, Scopus, Web of Science, ProQuest, Cochrane Library, and Google Scholar were searched without any time limitation on June 2022. The quality of the studies was evaluated with the CHEERS checklist. After data extraction, the results were synthesized by thematic content analysis.

Results

During the search, 3468 records were identified, of which 1061 were duplicates. 2407 titles and abstracts screened in terms of inclusion criteria. Finally, after studying 20 fulltexts, three of them were included in the study. The quality of these articles was scored between 10 and 16. These studies were from Spain, Denmark, and the United States from 2000 to 2019. Two studies showed that digital mammography is not as effective as other screening methods.

Conclusion

The results of this study showed that digital mammography is not very cost-benefit for the health care system. An increase in its repetition frequency imposes more costs on the health system and doesn't have more benefits for it.

Cost-Effectiveness of Breast Cancer Early Detection Program in Low- and Middle-Income Countries: A Systematic Review

OBJECTIVES

This review explores the cost-effectiveness of the strategies used in the breast cancer early detection programs of low- to middle-income countries.

METHODS

A systematic review was performed to identify related studies, published up to August 2021, on PubMed, Cochrane, ProQuest, and the Cumulative Index to Nursing and Allied Health Literature. The Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol were referenced during the reporting process. The Consolidated Health Economic Evaluation Reporting Standards 2022 criteria were used to assess the requirements of the selected studies. Articles with original data and full texts were included in the review. Non-low- to middle-income countries and non-English articles were excluded.

RESULTS

This review identified 12 suitable studies, wherein 6 investigated the cost-effectiveness of clinical breast examinations (CBEs), whereas 10 looked into mammogram (MMG) with or without CBE. In 2 studies, the cost-effectiveness of raising awareness through mass media and the use of ultrasounds combined with CBE were investigated. Although cost-effective, MMG incurs greater costs and requires more skill to be performed. MMG screenings before the age of 40 years were not cost-effective. The limitations of this review include variability in the methodological approaches of its selected studies. Most of the chosen studies met the Consolidated Health Economic Evaluation Reporting Standards 2022 criteria.

CONCLUSIONS

This review shows that adopting an age- and risk-based MMG screening approach could be viable in countries with limited resources. Future cost-effectiveness analysis research should include a section on patient and stakeholder engagement with the study's results.

Breast Cancer in Asia: Incidence, Mortality, Early Detection, Mammography Programs, and Risk-Based Screening Initiatives

Simple Summary

Nearly all breast cancer patients survive for more than five years when the tumor is found early and in the localized stage. Regular clinical breast examinations, mammograms, and monthly self-exams of the breasts all contribute to early detection. However, late-stage breast cancers are common in many Asian countries. Low-income countries suffer from a lack of resources for breast cancer screening. High-income countries, on the other hand, are not benefiting fully from national breast screening programs due to an underutilization of the preventive healthcare services available. Existing reviews on Asian breast cancers are heavily focused on risk factors. The question of whether we should adopt or adapt the knowledge generated from non-Asian breast cancers would benefit from an extension into screening guidelines. In addition, several Asian countries are piloting studies that move away from the age-based screening paradigm.

Abstract

Close to half (45.4%) of the 2.3 million breast cancers (BC) diagnosed in 2020 were from Asia. While the burden of breast cancer has been examined at the level of broad geographic regions, literature on more in-depth coverage of the individual countries and subregions of the Asian continent is lacking. This narrative review examines the breast cancer burden in 47 Asian countries. Breast cancer screening guidelines and risk-based screening initiatives are discussed.

Economic evaluations of mammography to screen for breast cancer in low- and middle-income countries: A systematic review

Background

Low- and middle-income countries (LMICs) have limited resources compared to high-income countries (HICs). Therefore, it is critical that LMICs implement cost-effective strategies to reduce the burden of breast cancer. This study aimed to answer the question of whether mammography is a cost-effective breast cancer screening method in LMICs.

Methods

A systematic article search was conducted through Medline, Embase, Web of Science, and Econlit. Studies were included only if they conducted a full economic evaluation and focused on mammography screening in LMICs. Two reviewers screened through the title and abstract of each article and continued with full-text selection. Data were extracted and synthesized narratively. Quality assessment for each included study was conducted using the Consensus Health Economic Criteria (CHEC) extended checklist.

Results

This review identified 21 studies economically evaluating mammography as a breast cancer screening method in LMICs. Eighteen of these studies concluded that mammography screening was a cost-effective strategy. Most studies (71%) were conducted in upper-middle-income countries (Upper MICs). The quality of the studies varied from low to good. Important factors determining cost-effectiveness are the target age group (eg, 50-59 years), the screening interval (eg, biennial or triennial), as well as any combination with other breast cancer control strategies (eg, combination with treatment strategy for breast cancer patients).

Conclusions

Mammography screening appeared to be a cost-effective strategy in LMICs, particularly in Upper MICs. More studies conducted in lower-middle-income and low-income countries are needed to better understand the cost-effectiveness of mammography screening in these regions.

Cost-effectiveness of screening mammography in a low income country: a Markov simulation analysis

Background

Breast cancer is the most common cancer diagnosed in women. Screening mammography is the only imaging screening study for breast cancer with a proven. mortality benefit. This study aims to analyze the cost-effectiveness of screening mammography in Ethiopia.

Methods

Multistate Markov model was used for computer simulation to estimate cost and health benefits of screening mammography interventions for age-group of 40–49 years and 50–59 years. The cost-effectiveness analysis was made for 4 policies based on where the screening mammography procedures were conducted: government institution only, the private institution only, 50% ratio for each, and 10% private institution policy. Outputs were expressed in total cost, life-years gained (LYG) incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INMB).

Results

All 4 policies of annual screening mammography failed to achieve acceptable ICER and lead to a net loss in INMB. The lowest ICER value was for government institution-only policy with 3510.3 USD/LYG and 3224.9 USD/LYG both above the cost-effectiveness threshold of 2808.5 USD. The cost per single death averted for each group was 110,206.7 USD and 77,088.2 USD for age-group 40–49 years and 50–59 years respectively.

Conclusion

Screening mammography could not be shown to be cost-effective in Ethiopia with the current low cost-effectiveness threshold. Alternative screening approach like annual clinical breast examination may need to be investigated.

Determinants of Breast Cancer Screening Practice among Women in Indonesia: A Nationwide Study

Background:

Breast cancer remains the leading cause of death for women globally, including in Indonesia. Breast cancer screening plays a vital role in reducing deaths caused by breast cancer. However, breast cancer screening rate is still low and studies on determinants for breast cancer screening is limited in Indonesia. This study aimed to identify the determinants of breast cancer screening among women in Indonesia.

Methods:

This population-based study was conducted among 827 women who lived in either rural and urban areas, using a stratified sampling design where were based on province and locality combinations. Data were analysed using a binary logistic regression model to assess the associations between independent and dependent variables.

Results:

As many as 827 women with an average age of 29.91 (± 11.14) years old participated in this study. The overall breast cancer screening among women was 18.74%. Knowledge of breast cancer risk factors, signs, and symptoms (adj.OR = 1.75, 95%CI: 1.20 – 2.56), age of 35 to 39 years old (adj.OR. = 1.52, 95% CI: 1.02 – 2.26), and household income of ≥6,000,000 IDR (≥457 USD) (adj.OR. = 5.19, 95%CI: 1.43–18.84) were associated with breast cancer screening attendance. In contrast, Christian women had a significantly lower breast cancer screening rate that women from other religions (adj. OR. = 0.45, 95%CI: 0.24 – 0.85).

Conclusion:

The overall breast cancer screening attendance was poor among Indonesian women population. Age, household income, religion, and knowledge of breast cancer risk factors were identified as the determinant factors for breast cancer screening.