A Scoping review of economic evaluation of breast cancer screening in China

Objectives: The cost-effectiveness of conventional population-based breast cancer screening strategies (e.g., mammography) has been found controversial, while evidence shows that genetic testing for early detection of pathogenic variants is cost-effective.

Methods: By systematically reviewing the economic evaluations of breast cancer screening in China, we aimed to confirm that the conventional strategies were economically unattractive, but the precision medicine technologies improved the cost-effectiveness. We searched PubMed, MEDLINE, and EMBASE to identify the economic evaluations that examined breast cancer screening and testing in China, supplemented by hand-searching the reference lists of the included studies. We finally included five studies that satisfied the reporting quality recommended by CHEERS.

Results: Four articles examined mammography while the rest investigated multi-gene testing. The existing breast cancer screening programs were found cost-effective among urban Chinese women, but one study concluded that they might cause harm to women in rural areas. Multigene testing was found significantly cost-effective and has a promising population impact among all breast cancer women in China. Contextual factors, such as data absence, urban-rural disparity, willingness-to-pay threshold, and model design, imposed barriers to cost-effectiveness analysis.

Conclusions: Future research should focus on the cost-effectiveness of screening and identifying breast cancer through precision medicine technologies, including genetic testing, genome sequencing, cascade testing, and the return of secondary findings. These precision medicine technologies may significantly improve the cost-effectiveness of breast cancer screening.