ArticleJournal of the National Cancer Institute2021
Cost-Effectiveness of Magnetic Resonance Imaging Screening for Women With Extremely Dense Breast Tissue.
Article in Journal of the National Cancer Institute, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
42 citing papers in PubMed, 4 syntheses or guidelines pooled it, 83 citations in OpenAlex.
- Health Economic Evaluations of Breast Cancer Screening Strategies: A Systematic Review Focusing on Methodology and Quality Assessment.Applied health economics and health policy · 2026Pooled it
- Clinical guidelines for the management of mammographic density: a systematic review of breast screening guidelines worldwide.JNCI cancer spectrum · 2024Pooled it
- Economic evaluation of breast MRI in screening - a systematic review and basic approach to cost-effectiveness analyses.Frontiers in oncology · 2023Pooled it
- Supplemental Screening as an Adjunct to Mammography for Breast Cancer Screening in People With Dense Breasts: A Health Technology Assessment.Ontario health technology assessment series · 2023Pooled it
- Impact of population based breast density notification: multisite parallel arm randomised controlled trial in BreastScreen.BMJ (Clinical research ed.) · 2025Trial
- AI-based selection of individuals for supplemental MRI in population-based breast cancer screening: the randomized ScreenTrustMRI trial.Nature medicine · 2024Trial
- Australian Women's Intentions and Psychological Outcomes Related to Breast Density Notification and Information: A Randomized Clinical Trial.JAMA network open · 2022Trial
- European Cancer Prevention Organization on cancer screening: an expert panel position paper.European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP) · 2026Article
- Cost-effectiveness of abbreviated breast MRI and contrast-enhanced mammography for women with extremely dense breasts in a national breast cancer screening program: a micro-simulation study.Breast (Edinburgh, Scotland) · 2026Article
- Assessment of Potentially Unnecessary Breast Magnetic Resonance Imaging Utilization and Its Economic Impact: A Retrospective Study.The Eurasian journal of medicine · 2026Article
- Adapted foundation models for breast MRI triaging in contrast-enhanced and non-contrast-enhanced protocols.European radiology · 2026Article
- Bridging the gap: clinical practice, guidelines, reimbursement and real-world challenges in breast imaging - webinar highlights.Future oncology (London, England) · 2026Article
- Surgical Perspective on the Updated American College of Radiology Supplemental Screening Guidelines for Breast Density.Annals of surgical oncology · 2026Article
- Outcomes of Density-Targeted Supplemental Breast Magnetic Resonance Imaging Screening by Breast Cancer Risk: Long-Term Health and Economic Considerations.Annals of internal medicine · 2026Article
- ESR Essentials: post-treatment breast cancer surveillance from mammography to a more personalised approach-practice recommendations by the European Society of Breast Imaging.European radiology · 2026Review
- Can a low b-value diffusion-weighted imaging sequence replace the standard T2-weighted fluid-sensitive sequence in breast MRI? A single-center prospective study.European radiology · 2025Article
- Review
- Breast MRI to Screen Women With Extremely Dense Breasts.Journal of magnetic resonance imaging : JMRI · 2025Review
- The Screening Tomosynthesis Trial with Advanced Reader Methods (STREAM): design and rationale of a population-based breast cancer screening trial.European radiology · 2025Article
- Further insights into the use of contrast-enhanced imaging for breast cancer follow-up: the pros view.European radiology · 2025Article
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Authors and funding
14 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundExtremely dense breast tissue is associated with increased breast cancer risk and limited sensitivity of mammography. The DENSE trial showed that additional magnetic resonance imaging (MRI) screening in women with extremely dense breasts resulted in a substantial reduction in interval cancers. The cost-effectiveness of MRI screening for these women is unknown.
methodsWe used the MISCAN-breast microsimulation model to simulate several screening protocols containing mammography and/or MRI to estimate long-term effects and costs. The model was calibrated using results of the DENSE trial and adjusted to incorporate decreases in breast density with increasing age. Screening strategies varied in the number of MRIs and mammograms offered to women ages 50-75 years. Outcomes were numbers of breast cancers, life-years, quality-adjusted life-years (QALYs), breast cancer deaths, and overdiagnosis. Incremental cost-effectiveness ratios (ICERs) were calculated (3% discounting), with a willingness-to-pay threshold of €22 000.
resultsCalibration resulted in a conservative fit of the model regarding MRI detection. Both strategies of the DENSE trial were dominated (biennial mammography; biennial mammography plus MRI). MRI alone every 4 years was cost-effective with €15 620 per QALY. Screening every 3 years with MRI alone resulted in an incremental cost-effectiveness ratio of €37 181 per QALY. All strategies with mammography and/or a 2-year interval were dominated because other strategies resulted in more additional QALYs per additional euro. Alternating mammography and MRI every 2 years was close to the efficiency frontier.
conclusionsMRI screening is cost-effective for women with extremely dense breasts, when applied at a 4-year interval. For a willingness to pay more than €22 000 per QALY gained, MRI at a 3-year interval is cost-effective as well.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.