Li Jingmei, Wong Fuh Yong, Wang Yi

Economic evaluation of a risk-based breast cancer screening approach in Singapore

Abstract Disclosures
Abstract: Breast tumors are most treatable when small and discovered early. Early detection of less-advanced breast cancers necessitates less aggressive treatment and confers a survival benefit. Mammography is the current standard used in population-based breast cancer screening. A substantial reduction in late-stage disease and breast cancer mortality is ascribed to screening mammography. When a participation rate of 70% within the target population receives mammography, a significant reduction in breast cancer mortality at the population level can be expected after 7-10 years. However, the low screening uptake and even lower adherence to regular screening is a major public health issue in Singapore. The BREAst screening Tailored for HEr (BREATHE) study, a prospective cohort study, endeavors to change the current age-based screening paradigm in a prospective study for women aged 35-59 years. The initiative uses validated breast cancer risk calculators incorporating genetic (breast cancer polygenic risk score and BOADICEA breast cancer predisposition genes) and non-genetic risk factors (Gail model, mammography density, recall status) to generate individual breast cancer risk profiles. Women at above average risk of developing breast cancer will be seen by breast specialists at the participating sites to discuss breast health and interventions for early breast cancer detection. Women who are currently in the “grey zone” (<50 years) of the national screening guidelines (not targeted by current health promotion efforts) will benefit from an awareness of their personal risk profiles and be better informed to make decisions.

To fully understand the health benefit and economic benefit of a new intervention, health technology assessment and economic evaluation need to be conducted. Existing literatures have demonstrated that risk-based breast cancer screening is cost effective compared to age-based screening. However, many of the previous literature were based on hypothetical scenarios. In this project, based on a real-world trial study, we aim to generate more robust evidence showing the cost effectiveness of risk-based breast cancer screening. 

This study aims to 1) evaluate the cost-effectiveness of the risk-based breast cancer screening strategy over current age-based paradigm in Singapore; 2) evaluate a change in screening frequencies for different risk groups and identify the optimal screening frequency for different risk groups. The study team hypothesis that risk-based breast cancer screening strategy is cost-effective compared to age-based cancer screening. Compared to current recommendation in Singapore, high-risk women should screen more frequently, and low-risk women should screen less frequently.



Joint Breast Cancer Registry Singapore