Overestimation of the Benefit-to-Harm Ratio of Risk-Based Mammography Screening in the United Kingdom

To the Editor Pashayan et al used a cost-effectiveness model (initially described by Pharoah et al) based on the UK mammography screening program to estimate the cost per quality-adjusted life-years (QALYs) gained associated with risk-based screening. The estimations consider QALYs gained owing to the reduced risk of breast cancer death associated with screening mammography and the QALYs lost owing to overdiagnosis. The results are interpreted using the threshold of £20 000 per QALY gained recommended by the UK National Institute for Health and Care Excellence (NICE). We agree that risk-based screening is a relevant way to optimize the harm-benefit balance of cancer screening; however, we disagree with 2 aspects of the cost-effectiveness model used by Pashayan et al.

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