Benefits and costs of screening Ashkenazi Jewish women for BRCA1 and BRCA2

Victor R. Grann, William Whang, Judith S. Jacobson, Daniel F. Heitjan, Karen H. Antman, Alfred I. Neugut

Research output: Contribution to journalArticlepeer-review

57 Scopus citations

Abstract

Purpose: To determine the survival benefit and cost-effectiveness of screening Ashkenazi Jewish women for three specific BRCA 1/2 gene mutations. Methods: We used a Markov model and Monte Carlo analysis to estimate the survival benefit and cost-effectiveness of screening for three specific mutations in a population in which their prevalence is 2.5% and the associated cancer risks are 56% for breast cancer and 16% for ovarian cancer. We assumed that the sensitivity and specificity of the test were 98% and 99%, respectively, that bilateral prophylactic oophorectomy would reduce ovarian cancer risk by 45%, and that bilateral prophylactic mastectomy would reduce breast cancer risk by 90%. We used Medicare payment data far treatment costs and Surveillance, Epidemiology, and End Results data for cancer survival. Results: Our model suggests that genetic screening of this population could prolong average nondiscounted survival by 38 days (95% probability interval, 22 to 57 days) for combined surgery, 33 days (95% probability interval, 18 to 43 days) for mastectomy 11 days (95% probability interval, 4 to 25 days) for oophorectomy, and 6 days (95% probability interval, 3 to 8 days) for surveillance. The respective cost-effectiveness ratios per life-year saved, with a discount rate of 3%, are $20,717, $29,970, $72,780, and $134,273. Conclusion: In this Ashkenazi Jewish population, with a high prevalence of BRCA1/2 mutations, genetic screening may significantly increase average survival and, depending on costs and screening/treatment strategies, may be cost-effective by the standards of accepted cancer screening tests. According to our model, screening is cost-effective only if all women who test positive undergo prophylactic surgery. These estimates require confirmation through prospective observational studies and clinical trials.

Original languageEnglish (US)
Pages (from-to)494-500
Number of pages7
JournalJournal of Clinical Oncology
Volume17
Issue number2
StatePublished - Feb 1999

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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