Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
J Natl Cancer Inst. 2022 Feb 7;114(2):235-244. doi: 10.1093/jnci/djab149.
Early initiation of breast cancer screening is recommended for high-risk women, including survivors of childhood cancer treated with chest radiation. Recent studies suggest that female survivors of childhood leukemia or sarcoma treated without chest radiation are also at elevated early onset breast cancer risk. However, the potential clinical benefits and cost-effectiveness of early breast cancer screening among these women are uncertain.
Using data from the Childhood Cancer Survivor Study, we adapted 2 Cancer Intervention and Surveillance Modeling Network simulation models to reflect the elevated risks of breast cancer and competing mortality among leukemia and sarcoma survivors. Costs and utility weights were based on published studies and databases. Outcomes included breast cancer deaths averted, false-positive screening results, benign biopsies, and incremental cost-effectiveness ratios.
In the absence of screening, the lifetime risk of dying from breast cancer among survivors was 6.8% to 7.0% across models. Early initiation of annual mammography with breast magnetic resonance imaging screening between ages 25 and 40 years would avert 52.6% to 64.3% of breast cancer deaths. When costs and quality-of-life impacts were considered, screening starting at age 40 years was the only strategy with an incremental cost-effectiveness ratio below the $100 000 per quality-adjusted life-year (QALY) gained cost-effectiveness threshold ($27 680 to $44 380 per QALY gained across models).
Among survivors of childhood leukemia or sarcoma, early initiation of breast cancer screening at age 40 years may reduce breast cancer deaths by half and is cost-effective. These findings could help inform screening guidelines for survivors treated without chest radiation.
建议对高危女性进行早期乳腺癌筛查，包括接受胸部放疗的儿童癌症幸存者。最近的研究表明，未接受胸部放疗的儿童白血病或肉瘤幸存者也存在早期乳腺癌发病风险增加的情况。然而，这些女性进行早期乳腺癌筛查的潜在临床获益和成本效益尚不确定。
利用来自儿童癌症幸存者研究的数据，我们改编了 2 个癌症干预和监测建模网络模拟模型，以反映白血病和肉瘤幸存者乳腺癌风险升高和竞争死亡的情况。成本和效用权重基于已发表的研究和数据库。结果包括乳腺癌死亡人数减少、假阳性筛查结果、良性活检和增量成本效益比。
在不进行筛查的情况下，模型预测白血病和肉瘤幸存者一生中死于乳腺癌的风险为 6.8%至 7.0%。25 岁至 40 岁之间每年进行乳房 X 线照相术和乳房磁共振成像筛查可以避免 52.6%至 64.3%的乳腺癌死亡。当考虑成本和生活质量的影响时，从 40 岁开始进行筛查是唯一一种增量成本效益比低于每获得 1 个质量调整生命年（QALY）10 万美元（QALY 增量成本效益比在各模型中为 27680 美元至 44380 美元）的策略。
对于儿童白血病或肉瘤幸存者，从 40 岁开始进行早期乳腺癌筛查可以减少一半的乳腺癌死亡人数，并且具有成本效益。这些发现可能有助于为未接受胸部放疗的幸存者制定筛查指南。
