Authors' objectives:

This report has three objectives:

(1) to analyse the impact of breast cancer screening on breast cancer mortality according to different screening strategies (age group and interval between mammographies),

(2) to estimate the cost-effectiveness of these strategies and

(3) to estimate the impact ofscreening on the health care system.

Breast cancer is the largest cause of cancer among Catalan women and it is estimated that there are 2,500 new cases each year (crude rate: 71.6 per 100,000 inhabitants per annum). In recent years a trend towards an increase in this figure has been observed. Catalonia falls in the intermediate-low segment of the European Union countries. Every year 1,000 women die from breast cancer in Catalonia. The mortality rate in recent years also shows a growing trend towards an increase in this disease, mainly in women aged over 65.

In Catalonia it has been recommended that breast cancer screening should be by biannual mammography for women aged 50-64 years. Once adequate coverage has been achieved for this age group, screening could be extended to the 65-69 age group and later to the 45-49 age group, providing that scientific evidence is conclusive for the latter age group. Currently screening programmes are operative in Molins dei Rei - Cornella, Mataro, Ciutat Vella-Sant Marti (Barcelona) and Sabadell-Cerdanyola, which cover 11% of the population of women aged 50-64 years. Other programmes in other health care regions are still in the planning stages.

Authors' results and conclusions: The expected reduction of mortality projected over a period of 27 years with the screening strategy chosen in Catalonia (women aged 50-64 years with a mammography every 2 years) is 12% per year. If the screening were extended to the age group of 65-69 years, there would be an annual reduction of 14.%. The selected screening strategy (50-64 years with a mammography every 2 years) is the most cost-effective one. The next most cost-effective strategy is to extend screening to women aged 64-69 years. However, if recent results from Swedish studies about the benefits of the screening in women aged 45-49 years were confirmed, the extension of the screening in this age group would present a cost-effectiveness ratio closer to other screening alternatives. However, the global cost of the programme is notably increased. To reduce the interval of the mammography from 2 to 1 year does not bring a proportional benefit, for the cost it implies. The sensitivity of the mammography and, mainly, the level of participation of the target populationhave an important influence on the expected benefits. The increase of external radiotherapy and brachytherapy related to the increase in the conservative treatment of breast cancer is one of the main consequences for health care activities of the introduction of massscreening. The cost of breast cancer therapy is similar to that observed in other countries, and it does not represent a high percentage of the health care expenses. However, the introduction of new therapeutic techniques may change this observation considerably.

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 1996

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research