Annual breast cancer surveillance for at-risk women recommended

Watchdog says screening should be granted to under-50s at higher risk over genetics or family history

DIT students  at the Spire in Dublin during a “Bra Walk” in aid of Action Breast Cancer last year. Breast cancer is the most common invasive cancer diagnosed in women in Ireland and the second most common cause of cancer death in women.  Photograph: Cyril Byrne/The Irish  Times

DIT students at the Spire in Dublin during a “Bra Walk” in aid of Action Breast Cancer last year. Breast cancer is the most common invasive cancer diagnosed in women in Ireland and the second most common cause of cancer death in women. Photograph: Cyril Byrne/The Irish Times

Thu, Apr 18, 2013, 13:09

Annual surveillance should be provided for women under 50 years of age who are at a higher risk of breast cancer due to a genetic predisposition or a strong family history, the State’s health watchdog has recommended.

The Health Information and Quality Authority (Hiqa) says surveillance for women from ages 30 to 49 using annual magnetic resonance imaging (MRI) is cost-effective.

From ages 40 to 49, the addition of an annual mammogram may also be considered, it recommends in a health technology report published today.

In another small cohort of women who have a high probability of breast cancer before age 30 (TP53 mutation carriers), annual MRI surveillance from age 20 to 49 is the optimal strategy recommended by Hiqa.

Hiqa has advised the National Cancer Control Programme (NCCP) on the implementation of an organised surveillance programme for women under age 50 in Ireland who are known to be at elevated risk of breast cancer due to these genetic and/or family history factors.

“Surveillance for these women can reduce the number of deaths compared to no surveillance,” said Dr Máirín Ryan, health technology assessment director at Hiqa, said.

“Women at high risk tend to have more aggressive tumours, so early detection is critical.”

Familial risk

Hiqa says that for women at high familial risk, but with no identified genetic mutations, and those at moderate risk, surveillance is not cost-effective compared to offering no surveillance. But it says that if the goal is to maximise health gain using existing resources and taking account of current international practice, then annual surveillance using mammograms from ages 40 to 49 is better than the current arrangements.

Dr Ryan continued: “The surveillance programmes recommended in the assessment would lead to a modest reduction in the cost to the health service compared to the existing arrangements.

“Given that fewer than 5,000 women in Ireland are identified as being at elevated risk, the resource and budget implications of a surveillance programme are estimated to be relatively modest.”

The report warns that unless a structured programmes is put in place, the available and type of surveillance will vary across the country, giving rise to inequitable care.

Cancer screening refers to monitoring those at average risk of a disease, while surveillance refers to the monitoring of those known to be an increased risk of the disease.

Breast cancer is the most common invasive cancer diagnosed in women in Ireland and the second most common cause of cancer death in women. In women aged less than 50 years, there are about 660 new cases of breast cancer diagnosed and 90 deaths each year.

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