Annual cancer testing proposed for at-risk women

Women under the age of 50 at greater risk of breast cancer due to family history or genetic predisposition should be checked annually as part of an organised surveillance programme, according to the Health Information and Quality Authority (Hiqa).

The higher the risk of developing the disease, the earlier the surveillance should begin, Hiqa says, in a report on behalf of the National Cancer Control Programme (NCCP). Included in the Hiqa recommendations are:

nAnnual MRI surveillance from age 20 to 49 for women who have a high probability of breast cancer before age 30. These are women with the genetic mutation TP53;

nAnnual MRI from age 30 to 49 for women with identified high penetrance genetic mutations other than TP53 (BRCA1 and BRCA2 genes);

nAnnual digital mammogram from age 40 to 49 for women at high familial risk with no identified genetic mutations;

nAnnual digital mammogram for women from age 40 to 49 who are at moderate risk.

After examining the potential cost of annual surveillance and the current surveillance available, Hiqa concluded that its recommendations, if implemented, would lead to a modest reduction in the cost to the health service compared to the existing arrangements.

Dr Máirín Ryan, director of health technology assessment at Hiqa, said a strategy of no surveillance would cost about €1.7m over five years arising from the cost of care for those who developed the disease.

To introduce the annual surveillance, Hiqa is proposing would only cost an additional €819,000 over five years, €90,000 less than the existing arrangements.

The ad hoc nature of current services means some women aged under 50 at elevated risk of breast cancer are offered surveillance, where “the frequency, type of imaging and starting age vary considerably”, said Dr Ryan.

She said that as fewer than 5,000 women are identified as being at elevated risk, “the resource and budget implications of a surveillance programme are estimated to be relatively modest”.

Surveillance for these women would reduce the number of deaths, she said: “Women at high risk tend to have more aggressive tumours, so early detection is critical.”

The board of Hiqa has approved the HTA report and it has been submitted to the NCCP.