Early detection of breast cancer proven cost-effective for Canada's health care system

Cancer screening is key to saving patients' lives since an earlier stage diagnosis improves survival rates, decreases morbidity, and leads to less intensive treatments. Early detection also has the potential to save Canada's health care system major money. The United States adopted breast cancer screening for women in their Forties due to an increase in the incidence of breast cancer in younger women, with recent research from the University of Ottawa confirming this rise.

Lead author Dr. Anna Wilkinson, an Associate Professor in the Faculty of Medicine at the University of Ottawa (uOttawa) and a GP oncologist at The Ottawa Hospital (TOH) Cancer Centre and with a team of researchers from uOttawa, including Dr. Jean Seely, and TOH – including Dr. Moira Rushton, a medical oncologist at the Ottawa Hospital Cancer Centre – collaborated with Sunnybrook Research Institute to examine the cost-effectiveness of breast cancer treatments at an earlier stage.

Dr. Wilkinson gave us an overview of this work, which was published in JAMA:

Question: What are the proven benefits of early detection of breast cancer?
Anna Wilkinson: "When breast cancers are detected at an early stage, less intensive treatments can be employed such as lumpectomies instead of mastectomies, single (sentinel) node biopsies instead of removing all the lymph nodes in the armpit, and often omitting chemotherapy and radiotherapy.

"Breast cancer survival is predicated by stage at diagnosis: the 5-year net survival for stage I breast cancer is 100 percent which, subsequently, declines to 92%, 74% and 23% with stage II, III and IV breast cancers."

Q: Why was it important to review the costs of screening now?
AW: "Recent debate over whether women aged 40 to 49 should be screened for breast cancer has crystallised the importance of understanding the economics of screening. In investigating this topic, we realised that cost effectiveness analyses are outdated and do not reflect expensive new advances that have become standard of care."

Q: What are the most recent advances and why has cost effectiveness not been incorporated?
AW: "The last few years have seen an explosion in exciting innovations in breast cancer treatment, which have resulted in improved breast cancer survival. These treatment successes translate into skyrocketing cost increases for advanced stage breast cancers. For example, new targeted therapies for high-risk stage II and III hormone sensitive breast cancers can cost nearly $142K over two years and over $210K for three years in the metastatic setting. A highly effective antibody drug conjugate for HER2 positive and HER2 low breast has a cost of $166K for one year of therapy and immunotherapy for triple negative breast cancer is $153K for one year of therapy. Stage IV costs for certain subtypes can rise past $500,000.

"Traditional costing models use population-level databases that have inherent time lags in data availability and do not reflect rapidly evolving costs. Our costing calculations were unique because all costs along the breast cancer continuum were included such as: diagnosis; pathology; radiology; surgery; radiation oncology; hospital stay; pharmacy; nursing; and palliative care costs."

Q: What kind of savings do you foresee?
AW: "We found that screening a cohort of women annually for breast cancer starting at age 40 to 74 saves the Canadian health care system $459.6M over these women's lifetime with 3,499 breast cancer deaths averted and 52,367 life years gained. This translates into a savings of $1, 880 for every women screened. The costs of screening mammograms and diagnostics are easily offset by treating cancers at earlier stages when it is less expensive."

Q: What kind of impact could early screening policy for breast cancer and other diseases have?
AW: "In an era where we will continue to see ever-more expensive, rapidly evolving treatments for cancer, diagnosing cancers early is a cost saving measure. We should see this study as a call for similar analyses of the cost effectiveness of early screening for colon, lung and cervical cancers. Evidence of costs savings with cancer screening could target the health inequities created by different cancer screening practices across Canada. The adoption of inclusive cancer screening presents a means to save money and optimize health equity, while improving cancer morbidity and mortality."