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Stronger breast cancer surveillance will reduce health service costs - report

A report published by HIQA today recommends annual scans for women who have an elevated risk due to familial or genetic factors.

File photo of doctor looking at mammogram.
File photo of doctor looking at mammogram.
Image: Rui Vieira/PA Wire

THE HEALTH INFORMATION and Quality Authority (HIQA) has recommended a stronger surveillance system for women at risk of breast cancer could actually save the health service money.

In a report published today, HIQA advised the National Cancer Control Programme (NCCP) on the implementation of an organised surveillance programme for women under 50 who are known to be at an elevated risk due to genetic or family history factors.

Director of health technology assessment at HIQA Dt Máirín Ryan said that surveillance for these women can “reduce the number of deaths compared to no surveillance”.

“Women at high risk tend to have more aggressive tumours, so early detection is critical,” she said. A woman will typically be considered high risk if two or more first degree relatives like a mother or sister had breast cancer before the age of 50.

The report concluded that for women aged 30 to 49 who have been identified to be carriers of certain genetic mutations, using annual MRI scans is cost-effective. From ages 40 to 49, the addition of an annual mammogram may also be considered.

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

The report goes on to said that surveillance for women at high familial risk but with no identified genetic mutations and those and moderate risk is not cost effective.

However HIQA said 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”.

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Ryan said the the programme recommended would lead to a “modest reduction” in the cost to the health service given that fewer than 5,000 women in Ireland are identified as being at elevated risk.

The estimated budget impact of managing cases with no surveillance is €1.7 million over five years. The approach recommended to the NCCP by HIQA is estimated to cost an additional €819,000 over five years, compared to an additional €908,000 over five years for existing ad hoc monitoring.

“Without a structured programme, the availability and type of surveillance offered varies across the country, giving rise to inequitable care,” she said. “An organised surveillance programme would improve equity of access.”

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 approximately 660 new cases of breast cancer diagnosed and 90 deaths each year.

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