Risk-based screening strategy averts more breast cancer deaths, reduces false positives
A risk-based breast cancer screening strategy may result in improved mortality rates in comparison to traditional age-based guidelines.
A new paper published this week in JAMA Network compares the five-year detection yield of both screening strategies. The findings suggest that risk-based screening leads to more averted cancers compared to age-based screening; such strategies also reduce instances of false positives.
The findings highlight the potential of looking beyond age and traditional risk factors to inform more long-term personalized screening recommendations, the authors write.
“By targeting women outside the highest-risk groups (e.g., breast cancer survivors, variant carriers, those with prior radiotherapy exposure, or high-risk benign lesions), risk-based screening could be associated with improved screening effectiveness and reduced associated harms,” Oguzhan Alagoz, PhD, with the department of industrial and systems engineering at the University of Wisconsin-Madison, and co-authors noted. “Using screening strategies that account for changes in absolute risk over time could enhance effectiveness over current recommendations by ensuring women at higher than average risk receive tailored screening, while those at low risk are less frequently screened.”
The team used a computer-based simulation to compare breast cancer outcomes under different screening approaches. They applied two established Cancer Intervention and Surveillance Modeling Network models to data from U.S. women who were 40 or older and had no history of breast cancer, testing multiple screening strategies based on either age or individual risk against a no-screening scenario. Five-year breast cancer risk was calculated to compare how outcomes differed based on screening strategy and risk level.
Nine of the risk-based strategies reviewed yielded comparable outcomes to those observed using biennial age-based recommendations for women ages 40 to 74. In some cases, risk-based models yielded higher detection rates, resulting in approximately 6% more averted cancer deaths. What’s more, strategies rooted in risk also produced 13% fewer false positives in comparison to traditional biennial methods.
The authors suggested their findings represent “a paradigm shift in breast cancer early detection,” adding that risk-based strategies benefit women with both high and low risk of developing cancer.
“By offering more intensive screening to women at high risk and less intensive screening to women at low risk, these strategies may be associated with similar benefits and reduced screening-associated burden. For instance, reducing unnecessary mammography and associated diagnostic workup for women at low risk lowers health care costs and decreases patient burden.”
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The paper also has an accompanying editorial, which can be found here. Researchers also published another study supporting risk-based breast cancer screening in JAMA last month. The American College of Radiology criticized the results, contending they did not provide enough evidence to warrant changes in breast cancer screening recommendations.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.