Defining Lifetime Risk Thresholds for Breast Cancer Surgical Prevention

作者：Wei Xia, Lea Mansour, Samuel Oxley, Caitlin T. Fierheller, Ashwin Kalra, Jacqueline Sia, Subhasheenee Ganesan, Michail Sideris, Li Sun, Adam R. Brentnall, Stephen W. Duffy, D. Gareth Evans, Li Yang, Rosa Legood, Ranjit Manchanda · 发表于：JAMA Oncology · 年份：2025 · DOI：10.1001/jamaoncol.2025.2203 · 被引用次数：7 · 研究领域：BRCA gene mutations in cancer、Breast Cancer Treatment Studies、Global Cancer Incidence and Screening

Importance: Expanding access to genetic testing and availability of validated breast cancer (BC) risk prediction models are increasingly identifying women at elevated BC risk who do not carry high-penetrance BRCA1/BRCA2/PALB2 pathogenic variants. The precise BC risk threshold for offering risk-reducing mastectomy (RRM) for BC prevention is unknown. Objective: To define the lifetime BC risk thresholds for RRM to be cost-effective compared with nonsurgical alternatives for BC prevention. Design, Setting, and Participants: This economic evaluation used a decision-analytic Markov model to compare the cost-effectiveness of RRM with BC screening and medical prevention in a simulated cohort. Extensive sensitivity analyses were performed. The study setting was from a UK payer perspective over a lifetime horizon until age 80 years. The simulated cohort included women aged 30 to 60 years at varying lifetime BC risks from 17% to 50%. The study was conducted between September 2022 and September 2024. Exposures: Undergoing RRM or receiving risk-stratified BC screening with medical prevention (tamoxifen or anastrozole). Main Outcomes and Measures: The incremental cost-effectiveness ratio was calculated as incremental cost per quality-adjusted life-year (QALY) gained and compared with the UK willingness-to-pay (WTP) threshold of £20 000 (US $27 037) to £30 000 (US $40 555) per QALY. BC cases prevented were estimated at the population level. Results: In the simulated cohort of 100 000 thirty...