Cost effectiveness of mammography focusing on mobile mammography for breast cancer screening in Iran: A review study

Document Type : Review Article

Authors

1 Professor, Department of Health Management and Economics Sciences, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

2 Professor, Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.

3 Professor, Department of Surgery, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

4 PhD of Health Management, Department of Health Management and Economics, School of public Health, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Breast cancer is one of the most common cancers and a leading cause of death worldwide and in Iran. Mammography is commonly used in breast cancer screening and diagnosis. This study was performed with aim to evaluate the efficacy and cost-effectiveness of mammography, especially the mobile type, in breast cancer screening in Iran.
Methods: This study is an overview of reviews. After a systematic search in the databases of Cochrane Library, Trip, Pubmed, CRD and magiran, the appropriate, relevant and up-to-date reports including systematic review, health technology assessment, economic assessment and clinical guidance were found and used.
Results: Mammography sensitivity for breast cancer screening in fixed type was reported between 84% and 96% and in mobile type between 77% and 98%. Its specificity has been reported between 50% and 100% in fixed type and between 92% and 95% in mobile type. In Iran, the use of mammography in the screening program increases the cost by about $ 37,000 per QALY (quality adjusted life years).
Conclusion: Due to the incidence of the disease, mammography is not cost effective in breast cancer screening, although in certain communities, for example, with a relatively high incidence may be cost effective. Mobile mammography is usually more expensive than fixed mammography and its technical performance is not much different, so it may be less cost effective than fixed mammography.

Keywords


  1. Astım E. Cost-effectiveness analysis of a prospective breast cancer screening program in Turkey (Master's thesis, Middle East Technical University); 2011.
  2. Savabi-Esfahani M, Ghasemi Gujani M, Babakhani Z, Tabatabaeyan M. Diagnostic accuracy of two methods of Breast light and thermography in breast cancer screening: A review study. Iran J Obstet Gynecol Infertil 2021; 24(2):86-95.
  3. Khoshnoud Khankahdani H, Parandin K. Comparative Cost-sharing Approaches in Calculating the Cost of Services by Using Activity Based Coting (ABC) Method in Radiology Department of Shiraz Ordibehesht Hospital. Journal of Governmental Accounting 2015; 2(1):83-92.
  4. Haghighat S, Akbari ME, Yavari P, Javanbakht M, Ghaffari S. Cost-effectiveness of three rounds of mammography breast cancer screening in Iranian women. Iranian journal of cancer prevention 2016; 9(1).
  5. Harirchi I, Kolahdoozan S, Karbakhsh M, Chegini N, Mohseni SM, Montazeri A, et al. Twenty years of breast cancer in Iran: downstaging without a formal screening program. Annals of oncology 2011; 22(1):93-7.
  6. Zehtab N, Jafari M, Barooni M, Nakhaee N, Goudarzi R, Zadeh MH. Cost-effectiveness analysis of breast cancer screening in rural Iran. Asian Pacific Journal of Cancer Prevention 2016; 17(2):609-14.
  7. Nguyen LH, Laohasiriwong W, Stewart JF, Wright P, Nguyen YT, Coyte PC. Cost-effectiveness analysis of a screening program for breast cancer in Vietnam. Value in health regional issues 2013; 2(1):21-8.
  8. Greif JM. Mammographic screening for breast cancer: An invited review of the benefits and costs. The Breast 2010; 19(4):268-72.
  9. Naeim A, Keeler E, Bassett LW, Parikh J, Bastani R, Reuben DB. Cost‐effectiveness of increasing access to mammography through mobile mammography for older women. Journal of the American Geriatrics Society 2009; 57(2):285-90.
  10. Barfar E, Rashidian A, Hosseini H, Nosratnejad S, Barooti E, Zendehdel K. Cost-effectiveness of mammography screening for breast cancer in a low socioeconomic group of Iranian women. Archives of Iranian Medicine 2014; 17(4):241-245.
  11. Foerster V. Portable and Mobile Mammography Screening Services. canadian agency for drugs and technologies in health; 2007.
  12. Sutton A, Clowes M, Preston L, Booth A. Meeting the review family: exploring review types and associated information retrieval requirements. Health Information & Libraries Journal 2019; 36(3):202-22.
  13. Rahimi G, Faizi Khankandy I, Nemati A, Shaker I, Sadeghzadeh Sadat I, Malekzadeh W, et al. Survey of Demographic Characteristics of Referred Patients for Mammography and Their Results at Fatemy Hospital in Ardabil. Journal of Health 2016; 7(1):95-101.
  14. EnayatRad M, Salehinia H. An investigation of changing patterns in breast cancer incidence trends among Iranian women. Journal of Sabzevar University of Medical Sciences 2015; 22(1):27-35.
  15. Asgarian F, Mirzaei M, Asgarian S, Jazayeri M. Epidemiology of breast cancer and the age distribution of patients over a period of ten years. Iranian Quarterly Journal of Breast Disease 2016; 9(1):31-36.
  16. Gennaro G, Di Maggio C. Dose comparison between screen/film and full-field digital mammography. European radiology 2006; 16(11):2559-66.
  17. Barr H, Blanco SA, Butler P, da Paz MA, Fleitas I, Craig G, et al. Mammography Services Quality Assurance: Baseline Standards for Latin America and the Caribbean. Washington D.C; 2016.
  18. Feig SA. Adverse effects of screening mammography. Radiologic Clinics 2004; 42(5):807-19.
  19. Dalley C, Basarir H, Wright JG, Fernando M, Pearson D, Ward SE, et al. Specialist integrated haematological malignancy diagnostic services: an Activity Based Cost (ABC) analysis of a networked laboratory service model. Journal of clinical pathology 2015; 68(4):292-300.
  20. Kriege M, Brekelmans CT, Obdeijn IM, Boetes C, Zonderland HM, Muller SH, et al. Factors affecting sensitivity and specificity of screening mammography and MRI in women with an inherited risk for breast cancer. Breast cancer research and treatment 2006; 100(1):109-19.
  21. Mohamadi Nekui H, Moghadam Ahmadi M, Kazemnejad E, Haghdoost A. Efficacy of Mammography for Diagnosis in Breast Mass Cases Among Different Age Groups. Journal of Guilan University of Medical Sciences 2015; 24(94):66-71.
  22. Kim HS, Kang BJ, Lee JH, Yim HW, Jung SE, Choi BG, et al. Sensitivity and Specificity of Screening Mammographies and Ultrasonographies Performed in Women at Seven Health Promotion Centers for One year. Journal of Korean Society of Ultrasound in Medicine 2010; 29(1):1-5.
  23. Ohuchi N, Suzuki A, Sobue T, Kawai M, Yamamoto S, Zheng YF, et al. Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial (J-START): a randomised controlled trial. The Lancet 2016; 387(10016):341-8.
  24. Akbari ME, Haghighatkhah H, Shafiee M, Akbari A, Bahmanpoor M, Khayamzadeh M. Mammography and ultrasonography reports compared with tissue diagnosis-an evidence based study in Iran, 2010. Asian Pacific Journal of Cancer Prevention 2012; 13(5):1907-10.
  25. Fontenoy AM, Langlois A, Chang SL, Daigle JM, Pelletier É, Guertin MH, et al. Contribution and performance of mobile units in an organized mammography screening program. Canadian Journal of Public Health 2013; 104(3):e193-9.
  26. Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V. Likelihood ratios for modern screening mammography: risk of breast cancer based on age and mammographic interpretation. Jama 1996; 276(1):39-43.
  27. Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V. Effect of age, breast density, and family history on the sensitivity of first screening mammography. Jama 1996; 276(1):33-8.
  28. Gultekin M, Ozturk C, Karaca S, Boztaş G, Turan SH, Dundar S, et al. Centralization of mammography reporting with mobile trucks: Turkish experience. Preventive medicine reports 2018; 10:317-22.
  29. Greenwald ZR, El-Zein M, Bouten S, Ensha H, Vazquez FL, Franco EL. Mobile screening units for the early detection of cancer: a systematic review. Cancer Epidemiology and Prevention Biomarkers 2017; 26(12):1679-94.
  30. Brooks SE, Hembree TM, Shelton BJ, Beache SC, Aschbacher G, Schervish PH, et al. Mobile mammography in underserved populations: analysis of outcomes of 3,923 women. Journal of community health 2013; 38(5):900-6.
  31. Stanley E, Lewis MC, Irshad A, Ackerman S, Collins H, Pavic D, et al. Effectiveness of a mobile mammography program. American Journal of Roentgenology 2017; 209(6):1426-9.
  32. Chen YR, Chang-Halpenny C, Kumarasamy NA, Venegas A, Braddock III CH. Perspectives of mobile versus fixed mammography in Santa Clara County, California: a focus group study. Cureus 2016; 8(2).
  33. Carkaci S, Geiser WR, Adrada BE, Marquez C, Whitman GJ. How to establish a cost-effective mobile mammography program. American Journal of Roentgenology 2013; 201(5):W691-7.
  34. Vallée A. Is “mobile mammography” a Relevant Method in France?. Sante Publique 2016; 28(5):599-602.
  35. Haikel RL, Mauad EC, Silva TB, de Castro Mattos JS, Chala LF, Longatto-Filho A, et al. Mammography-based screening program: preliminary results from a first 2-year round in a Brazilian region using mobile and fixed units. BMC women's health 2012; 12(1):1-7.
  36. Moutel G, Duchange N, Darquy S, de Montgolfier S, Papin-Lefebvre F, Jullian O, et al. Women’s participation in breast cancer screening in France–an ethical approach. BMC medical ethics 2014; 15(1):1-8.
  37. Rashidian A, Barfar E, Hosseini H, Nosratnejad S, Barooti E. Cost effectiveness of breast cancer screening using mammography; a systematic review. Iranian journal of public health 2013; 42(4):347.
  38. Davari M, Mokarian F, Hosseini M, Aslani A, Nazari A, Yazdanpanah F. Direct Medical Costs of Breast Cancer in Iran, Analyzing Patients Level Data From A Cancer Specific Hospital in Isfahan, Iran. Health Information Management 2013; 10(3):1-10.
  39. Boyd NF, Guo H, Martin LJ, Sun L, Stone J, Fishell E, et al. Mammographic density and the risk and detection of breast cancer. New England journal of medicine 2007; 356(3):227-36.
  40. Saarenmaa I, Salminen T, Geiger U, Heikkinen P, Hyvärinen S, Isola J, et al. The effect of age and density of the breast on the sensitivity of breast cancer diagnostic by mammography and ultasonography. Breast cancer research and treatment 2001; 67(2):117-23.
  41. World Health Organization. Policy statements and recommended actions for early detection of cancer in the Eastern Mediterranean Region. World Health Organization. Regional Office for the Eastern Mediterranean; 2016.