Cost-effectiveness of three rounds of mammography breast cancer screening in Iranian women

Background: Breast cancer is the most common cancer in Iranian women as is worldwide. Mammography screening has been introduced as a beneficial method for reducing mortality and morbidity of this disease

Objectives: We developed an analytical model to assess the cost effectiveness of an organized mammography screening program in Iran for early detection of the breast cancer

Patients and Methods: This study is an economic evaluation of mammography screening program among Iranian woman aged 40 - 70 years. A decision tree and Markov model were applied to estimate total quality adjusted life years [QALY] and lifetime costs

Results: The results revealed that the incremental cost effectiveness ratio [ICER] of mammography screening in Iranian women in the first round was Int. 37,350 dollars per QALY gained. The model showed that the ICER in the second and third rounds of screening program were Int.141,641 dollars and Int. 389,148 dollars respectively

Conclusions: Study results identified that mammography screening program was cost-effective in 53% of the cases, but incremental cost per QALY in the second and third rounds of screening are much higher than the accepted payment threshold of Iranian health system. Thus, evaluation of other screening strategies would be useful to identify more cost-effective program. Future studies with new national data can improve the accuracy of our finding and provide better information for health policy makers for decision making

Comparison of clinicopathological characteristics and outcome of inflammatory and non-inflammatory locally advanced breast cancer: a study in Iran

Background: Inflammatory breast cancer [IBC], a subgroup of locally advanced breast cancer [LABC], is diagnosed based on clinical findings, and seems to be different from other types of LABC. The purpose of this study was to compare clinicopathological characteristics and outcomes between inflammatory and non-inflammatory LABC patients at Breast Cancer Research Center [BCRC], Tehran, Iran. Methods: The medical records of all patients who were diagnosed as LABC in BCRC since 1997 to 2011 were extracted from the database. Then, clinical and pathological characteristics and overall survival of IBC patients were compared with non-inflammatory LABC [NI-LABC]. Results: A total number of 340 patients were identified as LABC from which 17 patients [5%] were diagnosed as IBC. Menopausal status, body mass index [BMI], family history of breast cancer, nodal status, and Her2/neu and PR positivity were not statistically different between IBC and NI-LABC groups. The difference in estrogen receptor [ER] between the two groups was significant [P = 0.028]. Median duration of follow-up was 26.50 months. Patients with IBC had overall survival of 27.9 months [95% CI: 22.7–33.1] which was lower than patients in the NI-LABC group with a survival of 118.9 months [95% CI: 107.3–130.6] [P = 0.015]. The difference between the disease-free survivals of the two groups were also statistically significant [P < 0.001]. Conclusions: Compared to NI-LABC, IBC is more frequently ER negative and more commonly associated with lower survival rate. These findings reinforce the idea that IBC has a more aggressive biology and more unfavorable outcome than NI-LABC and needs close follow-up