Cost-effective screening for breast cancer worldwide: current state and future directions

A Sarvazyan, V Egorov, J S Son, C S Kaufman, A Sarvazyan, V Egorov, J S Son, C S Kaufman

Abstract

Affordability of healthcare is highly limited by its skyrocketing cost. Access to screening and diagnostic medical equipment and medicine in developing countries is inadequate for the majority of the population. There is a tremendous worldwide need to detect breast cancer at its earliest stage. These needs must be balanced by the ability of countries to provide breast cancer screening technology to their populations. We reviewed the diagnostic accuracy, procedure cost and cost-effectiveness of currently available technique for breast screening and diagnosis including clinical breast examination, mammography, ultrasound, magnetic resonance imaging, biopsy and a new modality for cancer diagnostics termed elasticity imaging that has emerged in the last decade. Clinical results demonstrate that elasticity imaging even in its simplest and least sophisticated versions, like tactile imaging, has significant diagnostic potential comparable and exceeding that of conventional imaging techniques. In view of many countries with limited resources, effective yet less expensive modes of screening must be considered worldwide. The tactile imaging is one method that has the potential to provide cost-effective breast cancer screening and diagnostics.

Keywords: breast cancer; cost-effectiveness; elastography; screening.

Figures

Figure 1.
Figure 1.
Population of women (first column), breast cancer deaths (second column) and mammography processes (third column) in developing countries (red boxes) in comparison with developed countries (grey boxes). The data are for 2005 [62]. Abbreviations: NA: North America; WE: Western Europe; JPN: Japan; LA: Latin America; EEMEA: Eastern Europe, Middle East, Africa; APAC: Asian Pacific, Australia, China.
Figure 2.
Figure 2.
Relative cost of mammography equipment vs. physician adoption.

References

    1. Anderson BO, Shyyan R, Eniu A, Smith RA, Yip CH, Bese NS, Chow LW, Masood S, Ramsey SD, Carlson RW. Breast cancer in limited-resource countries: an overview of the Breast Health Global Initiative 2005 guidelines. Breast J. 2006;12(Suppl 1):S3–15.
    1. World Health Organization “Fact sheet N° 297.” February2006. Available on line at:
    1. Medicare Reimbursement for Mammography Services Available on line at:
    1. Pisano ED, Gatsonis C, Hendrick E, et al. Diagnostic performance of digital versus film mammography for breast-cancer screening. N. Engl. J. Med. 2005;353(17):1773–83.
    1. Tosteson ANA, et al. Cost-Effectiveness of Digital Mammography Breast Cancer Screening. Annals of Internal Medicine. 2008;148(1):1–10.
    1. Laxminarayan R, Chow J, Shahid-Salles SA. Intervention Cost-Effectiveness: Overview of Main Messages. In: Jamison DT, et al., editors. Disease Control Priorities in Developing Countries. 2nd Edition. Oxford University Press; 2006. pp. 35–86.
    1. Semiglazov VF, Manikhas AG, Moiseenko VM, et al. Results of a prospective randomized investigation to evaluate the significance of self-examination for the early detection of breast cancer (Russia) Vopr. Onkol. 2003;49(4):434–41.
    1. Thomas DB, Gao DL, Ray RM, et al. Randomized trial of breast self-examination in Shanghai: final results. J. Natl. Cancer Inst. 2002;94(19):1445–57.
    1. McCready T, Littlewood D, Jenkinson J. Breast self-examination and breast awareness: a literature review. J. Clin. Nurs. 2005;14(5):570–8.
    1. American Cancer Society . Breast Cancer Facts and Figures 2007–2008. Atlanta: American Cancer Society, Inc; 2008. pp. 1–36.
    1. Altmann A, Hellerhoff K, Heywang-Köbrunner SH. Screening in Women with Increased Breast Cancer Risk. Breast Care. 2006;1:22–5.
    1. Oestreicher N, White E, Lehman CD, et al. Predictors of sensitivity of clinical breast examination (CBE) Breast Cancer Res. Treatment. 2002;76:73–81.
    1. Bancej C, Decker K, Chiarelli A, et al. Contribution of clinical breast examination to mammography screening in the early detection of breast cancer. J. Med. Screen. 2003;10:16–14.
    1. Saslow D, Hannan J, Osuch J, et al. Clinical breast examination: practical recommendations for optimizing performance and reporting. CA Cancer J. Clin. 2004;54(6):327–44.
    1. Barton MB, Harris R, Fletcher SW. Does this patient have breast cancer? The screening clinical breast examination: Should it be done? How. JAMA. 1999;282:1270–80.
    1. Haagensen CD. Diseases of the Breast. 3rd ed. Philadelphia: W.B. Saunders Company; 1986. p. 502.
    1. Bobo JK, Lee NC, Thames SF. Findings from 752,081 clinical breast examinations reported to a national screening program from 1995 through 1998. J. Natl. Cancer Inst. 2000;92:971–6.
    1. Brown ML, Goldie SJ, Draisma G, Harford J, Lipscomb J. Health Service Interventions for Cancer Control in Developing Countries. In: Jamison DT, et al., editors. Disease Control Priorities in Developing Countries. 2nd Edition. Oxford University Press; 2006. pp. 569–89.
    1. Skaane P, Hofvind S, Skjennald A. Randomized trial of screen-film versus full-field digital mammography with soft-copy reading in population-based screening program: follow-up and final results of Oslo II study. Radiology. 2007;244(3):708–17.
    1. Helve MA. Imaging Analysys: Mammography In: Diseases of the Breast. 3rd ed. Wolters Kluwer Company; Philadelphia: 2004. pp. 131–48.
    1. Bevers TB. Breast Cancer Screening and Diagnosis Guidelines. National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology. 2006;1:1–38.
    1. Ely S, Vioral AN. Breast cancer overview. Plast. Surg. Nurs. 2007;27(3):128–33.
    1. Nemec CF, Listinsky J, Rim A. How should we screen for breast cancer? Mammography, ultrasonography, MRI. Cleve Clin. J. Med. 2007;74(12):897–904.
    1. Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast cancer screening in women with a familial or genetic predisposition. N. Engl. J. Med. 2004;351:427–37.
    1. Leach MO, Boggis CR, Dixon AK, et al. Screening with magnetic resonance imaging and mammography of a U.K population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS) Lancet. 2005;365:1769–78.
    1. Warner E, Plewes DB, Hill KA, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA. 2004;292:1317–25.
    1. Kuhl CK, Schrading S, Leutner CC, et al. Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J. Clin. Oncol. 2005;23:8469–76.
    1. Lehman CD, Blume JD, Weatherall P, et al. Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer. 2005;103:1898–1905.
    1. Sardanelli F, Podo F. Breast MR. imaging in women at high risk of breast cancer. Is something changing in early breast cancer detection? Eur. Radiol. 2007;17(4):873–87.
    1. Skovoroda AR, Klishko AN, Gusakyan DA, Mayevskii YE, Yermilova VD, Oranskaya GA, Sarvazyan AP. Quantitative analysis of the mechanical characteristics of pathologically changed soft biological tissues. Biophsics. 1995;40(6):1359–64.
    1. Krouskop TA, Wheeler TM, Kallel F, Garra BS, Hall T. Elastic moduli of breast and prostate tissues under compression. Ultrason. Imaging. 1998;20(4):260–74.
    1. Sarvazyan AP. Elastic properties of soft tissue. In: Levy, Bass, Stern, editors. Handbook of Elastic Properties of Solids, Liquids and Gases, Volume III, Chapter 5. Academic Press; 2001. pp. 107–27.
    1. Parker KJ, Huang SR, Musulin RA, Lerner RM. Tissue response to mechanical vibrations for “sonoelasticity imaging”. Ultrasound Med. Biol. 1990;16(3):241–6.
    1. Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrasonic Imaging. 1991;13:111–34.
    1. Sarvazyan AP, Skovoroda AR, et al. Biophysical bases of elasticity imaging. In: Jones JP, editor. Acoustical Imaging. Vol. 21. Plenum Press; New York and London: 1995. pp. 223–40.
    1. Manduca A, Oliphant TE, et al. Magnetic resonance elastography: Non-invasive mapping of tissue elasticity. Med. Image Anal. 2001;5:237–54.
    1. Nightingale K, Soo MS, Nightingale R, Trahey G. Acoustic radiation force impulse imaging: in vivo demonstration of clinical feasibility. Ultrasound Med. Biol. 2002;28(2):227–35.
    1. Greenleaf JF, Fatemi M, Insana M. Selected methods for imaging elastic properties of biological tissues. Annu. Rev. Biomed. Eng. 2003;5:57–78.
    1. Sarvazyan AP, Rudenko OV, Swanson SD, Fowlkes JB, Emelianov SY. Shear Wave Elasticity Imaging-a new ultrasonic technology of medical diagnostics. Ultrasound Med. Biol. 1998;24:1419–35.
    1. Giovannini M, Hookey LC, Bories E, Pesenti C, Monges G, Delpero JR. Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients. Endoscopy. 2006;38(4):344–48.
    1. Kiss MZ, Hobson MA, Varghese T, Harter J, Kliewer MA, Hartenbach EM, Zagzebski JA. Frequency-dependent complex modulus of the uterus: preliminary results. Phys. Med. Biol. 2006;51(15):3683–95.
    1. Bensamoun SF, Ringleb SI, Littrell L, Chen Q, Brennan M, Ehman RL, An KN. Determination of thigh muscle stiffness using magnetic resonance elastography. J. Magn. Reson. Imaging. 2006;23(2):242–47.
    1. Lyshchik A, Higashi T, Asato R, Tanaka S, et al. Thyroid Gland Tumor Diagnosis at U.S. Elastography. Radiology. 2005;237(1):202–11.
    1. Goss BC, McGee KP, Ehman EC, Manduca A, Ehman RL. Magnetic resonance elastography of the lung: Technical feasibility. Magn. Reson. Med. 2006;56(5):1060–6.
    1. Gomez-Dominguez E, Mendoza J, Rubio S, Moreno-Monteagudo JA, Garcia-Buey L, Moreno-Otero R. Transient elastography: a valid alternative to biopsy in patients with chronic liver disease. Aliment. Pharmacol. Ther. 2006;24(3):513–18.
    1. Baldewsing R, Schaar J, Mastik F, van der Steen A. Local Elasticity Imaging of Vulnerable Atherosclerotic Coronary Plaques. In: Safar ME, Frohlich ED, editors. Atherosclerosis, Large Arteries and Cardiovascular Risk Adv Cardiol. Vol. 44. Basel: Karger; 2007. pp. 35–61.
    1. Itoh A, Ueno E, Tohno E, et al. Breast Disease: Clinical Application of U.S Elastography for Diagnosis. Radiology. 2006;9(2):341–50.
    1. Zhang XF, Liu XM, Bao XF, Peng XJ, Zhang W, Xu J. Application of real-time tissue elastography in diagnosis of breast cancer. Article in Chinese, Zhejiang Da Xue Xue Bao Yi Xue Ban. 2006;35(4):444–7.
    1. Thomas A, Fischer T, Frey H, Ohlinger R, Grunwald S, Blohmer JU, Winzer KJ, Weber S, Kristiansen G, Ebert B, Kummel S. Real-time elastography—an advanced method of ultrasound: First results in 108 patients with breast lesions. Ultrasound Obstet. Gynecol. 2006;28(3):335–40.
    1. Sinkus R, Siegmann K, Tanter M, Xydeas T, Fink M. MR.—elastography is capable of increasing the specificity of MR.-mammography—influence of rheology on the diagnostic gain. Proceedings of the 5th International Conference on the Ultrasonic Measurement and Imaging of Tissue Elasticity; Snowbird, Utah, U.S.A. 2006. p. 111.
    1. Regner DM, Hesley GK, Hangiandreou NJ, Morton MJ, Nordland MR, Meixner DD, Hall TJ, Farrell MA, Mandrekar JN, Harmsen WS, Charboneau JW. Breast lesions: evaluation with U.S strain imaging—clinical experience of multiple observers. Radiology. 2006;238(2):425–37.
    1. Barr RG, Grajo GR. Proceedings of the 6th International Conference on the Ultrasonic Measurement and Imaging of Tissue Elasticity. Santa Fe, New Mexico, U.S.A.: 2007. Initial results of real-time elasticity imaging in the evaluation of breast lesions; p. 94.
    1. Garra BS, Mobbs LM, Chant CM, Ophir J. Clinical breast elastography: blinded reader performance and strategies for improving reader performance. Proceedings of the 5th International Conference on the Ultrasonic Measurement and Imaging of Tissue Elasticity; Snowbird, Utah, U.S.A.. 2006. p. 60.
    1. Burnside ES, Hall TJ, Sommer AM, Hesley GK, Sisney GA, Svensson WE, Fine JP, Jiang J, Hangiandreou NJ. Differentiating benign from malignant solid breast masses with U.S strain imaging. Radiology. 2007;245(2):401–10.
    1. Svensson WE, Zaman N, Barrett NK, Ralleigh G, Satchithananda K, Comitis S, Gada V, Wakeham NR. Proceedings of the 6th International Conference on the Ultrasonic Measurement and Imaging of Tissue Elasticity. Santa Fe, New Mexico, U.S.A.: 2007. Breast elasticity imaging aids patient management in the one stop breast clinic; p. 128.
    1. Sarvazyan AP. Mechanical Imaging: A new technology for Medical Diagnostics. Int. J. Med. Inf. 1998;49:195–216.
    1. Kaufman CS, Jacobson L, Bachman B, Kaufman L. Digital documentation of the physical examination: moving the clinical breast exam to the electronic medical record. The Amer. J. Surg. 2006;192:444–9.
    1. Egorov V, Ayrapetyan S, Sarvazyan AP. Prostate Mechanical Imaging: 3-D image composition and feature calculations. IEEE Trans. Med. Imaging. 2006;25(10):1329–40.
    1. Weiss RE, Egorov V, Ayrapetyan S, Sarvazyan N, Sarvazyan AP. Prostate mechanical imaging: a new method for prostate assessment. Urology. 2008;71(3):425–9.
    1. Egorov V, Kearney T, Pollak SB, Rohatgi C, Sarvazyan N, Airapetian S, Browning S, Sarvazyan AP. Differentiation of benign and malignant breast lesions by mechanical imaging. 2008. Submitted for Publication.
    1. Egorov V, Sarvazyan AP. Mechanical imaging of the breast. IEEE Trans. Med. Imaging. 2008 Accepted for publication.
    1. Liang W, Lawrence W, Burnett CB, et al. Acceptability of diagnostic tests for breast cancer. Breast Cancer Res. Treat. 2003;79:199–206.
    1. Gur D, Wallace LP, Klym AH, Hardesty LA, Abrams GS, Shah R, Sumkin JH. Trends in Recall, Biopsy, and Positive Biopsy Rates for Screening Mammography in an Academic Practice. Radiology. 2005;235:396–401.
    1. Venta LA. Diseases of the Breast. 3rd ed. Wolters Kluwer Company; Philadelphia: 2004. Image-guided biopsy of nonpalpable breast lesions; pp. 199–219.
    1. Groenewoud JH, Pijnappel RM, van den Akker-van Marle ME, et al. Cost-effectiveness of stereotactic large-core needle biopsy for nonpalpable breast lesions compared to open-breast biopsy. British J. Cancer. 2004;90:383–92.
    1. Hillner BE, Hayman JA. Diseases of the Breast. 3rd ed. Wolters Kluwer Company; Philadelphia1: 2004. Cost and cost-effectiveness considerations; pp. 497–513.
    1. World Health Organization WHOSIS Database . Mammography World Markets, Trimark Publications, 2005. U.S Census Bureau (2005); 2005.
    1. Saslow D, Boetets C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer Journal for Clinicians. 2007;57:75–89.
    1. Ohnuki K, Kuriyama S, Shoji N, Nishino Y, Tsuji I, Ohuchi N. Cost-effectiveness analysis of screening modalities for breast cancer in Japan with special reference to women aged 40–49 years. Cancer Science. 2006;97(11):1242–47.
    1. Young KC. Radiation doses in the U.K trial of breast screening in women aged 40–48 years. Br. J. Radiol. 2002;75:362–70.
    1. Howe GR, McLaughlin J. Breast cancer mortality between 1950 and 1987 after exposure to fractionated moderate-dose-rate ionizing radiation in the Canadian fluoroscopy cohort study and a comparison with breast cancer mortality in the atomic bomb survivors study. Radiat. Res. 1996;145:694–707.
    1. Mattsson A, Rudén BI, Hall P, Wilking N, Rutqvist LE. Radiation-induced breast cancer: long-term follow-up of radiation therapy for benign breast disease. J. Natl. Cancer Inst. 1993;85:1679–85.
    1. Cardis E, Hall J, Tavtigian SV. Identification of women with an increased risk of developing radiation-induced breast cancer. Breast Cancer Res. 2007;9(3):106.
    1. Armstrong K, Moye E, Williams S, Berlin JA, Reynolds EE. Screening mammography in women 40 to 49 years of age: a systematic review for the American College of Physicians. Ann. Intern. Med. 2007;146(7):516–26.
    1. Tanter M, Bercoff J, Athanasiou A, Deffieux T, Gennisson JL, Montaldo G, Muller M, Tardivon A, Fink M. Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear imaging. Ultrasound Med. Biol. 2008 Apr 4; [Epub ahead of print].

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