Risk-based breast cancer screening may be more beneficial than age-based screening, according to research published January 20 in JAMA Network Open.
A team led by Oguzhan Alagoz, PhD, from the University of Wisconsin-Madison used five-year invasive breast cancer risk data for a study that found that population risk-based screening led to “similar or greater benefits” compared with age-based screening and reduced false-positive recalls.
“By shifting the focus from uniform population-wide recommendations based on age alone to individualized risk-based strategies, these approaches were projected to maintain or improve mortality benefits while reducing the burden of screening harms,” the Alagoz team wrote.
Age is factored into breast cancer screening criteria. The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women ages 40 to 74, a B-grade recommendation. It also says there is insufficient evidence to make a recommendation for screening for women ages 75 and older.
However, the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) both call for annual screening starting at age 40. They also recommend women continue with annual screening past age 74 unless severe comorbidities limit life expectancy.
Alagoz and colleagues highlighted that current recommendations for screening mammography “do not consider absolute risk of individual women at a given age.” They added that consideration of individual breast cancer risk requires that clinicians and women have access to accurate, well-calibrated risk assessment tools.
The researchers compared outcomes of screening strategies that vary by five-year risk of invasive breast cancer versus age-based strategies, using digital breast tomosynthesis (DBT). They used a decision analytical model that included two established Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer models. With these, the researchers simulated U.S. women born in 1980 who were aged 40 years or older without a prior history of breast cancer.
The team identified nine risk-based screening strategies that were tied to a similar or greater number of averted deaths compared with biennial age-based screening from ages 40 to 74 years. This included a range of 6.8 to 7.5 per 1,000 women for the risk-based strategies versus 6.8 per 1,000 women for biennial age-based screening with DBT.
All risk-based screening strategies considered in the study accounted for changes in risk as a woman aged. These required risk estimates every five years or whenever a patient chose to reassess her screening pattern.
The risk-based strategies also led to reduced false-positive recalls by 8% to 23% (1,050 to 1,257 per 1,000 women) versus 1,365 per 1,000 women for the age-based approach.
“For example, a risk-based approach using a combination of biennial screening and annual screening would be associated with 6% more breast cancer deaths averted than age-based screening [7.2 versus 6.8 per 1,000 women] and 13% fewer false-positive recalls [1,190 versus 1,365 per 1,000 women],” the researchers wrote.
The team noted that these results were consistent across the two CISNET models. Finally, the relative difference in life-years gained between the age-based and risk-based screening strategies “is less pronounced than the difference in breast cancer deaths averted,” the team wrote.
The results suggest a paradigm shift in breast cancer early detection through risk-based screening, the study authors highlighted.
“As personalized medicine advances, risk-based screening is poised to become a cornerstone of breast cancer prevention, offering a more nuanced and tailored approach to patient care,” they wrote.
ACR responds to study
Read the full study here.