Harnessing technology for precision public health is key to preventing disease and improving individual health and the health of the population. In breast cancer prevention, advances in our understanding of the why, how and who of disease development, combined with new technologies, are creating opportunities for improving personalised prevention. Clearer understanding of risk factors is informing risk stratification, which in turn enables tailored preventive interventions. The availability of digital apps has also opened new avenues for how health systems can help individuals and populations to stay healthy.
Over the last five years the EU funded consortium, B-CAST, has been examining this potential. PHG Foundation has been part of that programme, helping researchers and policy-makers grapple with the implications science has for health systems, individuals and society
The case for change
Our understanding of breast cancer is evolving, as are methods at our disposal to prevent it. The time is now right to adapt our approach to prevention: taking advantage of new knowledge about this heterogenous disease and the ability to bring greater precision to defining risk levels. This doesn’t mean abandoning what has been done so far. Rather, we want to strengthen it using the available technologies and pathways to achieve a better balance of benefits and harms. For example, reaping the benefits of detecting breast cancer early so it can be treated and balancing this against the inconvenience of frequent screening and the harms of overdiagnosis.
Opportunities to improve personalised prevention
Preventing breast cancer is not easy. It is a complex disease that requires a full suite of approaches targeted both at individuals and populations. For instance, addressing lifestyle factors such as diet and physical activity are important for reducing risk - as policymakers focus more on prevention and population-wide health promotion activities are developed, it is important to consider how to include breast cancer risk information for personalised health promotion purposes at different life stages.
As we learn more about the genetics of breast cancer, we also need to agree how best to use this valuable information. This is particularly important as genetic testing becomes more available to women through different avenues such as research studies, clinical initiatives and direct to consumer companies. Agreeing guidelines on the breadth of testing that is carried out and how best to follow-up on the results of tests is a priority.
Taking a risk-adapted approach to screening for breast cancer has been discussed for many years and could be beneficial. However, implementing change to screening programmes is never a simple task, especially when the benefits and harms are not immediately obvious or are hard to quantify. Furthermore, there are several available options for how such an approach could be taken forward, each with its own implications for screening pathways and public acceptability.
Making personalised breast cancer prevention a reality
Science and technology are creating new possibilities for our approach to breast cancer prevention, but possibilities create uncertainty. The complexities of breast cancer and its prevention, combined with these uncertainties can make decision making difficult. Developing a clear picture of the evidence gaps and achieving sustainable change requires clear, open, and transparent engagement by policy makers with all participants in prevention: individuals, service providers, payers. Our report, Personalising breast cancer prevention – bridging the gap between research and policy contributes to this process by setting out for policy makers with the implications emerging science has for prevention pathways.
The high population morbidity and mortality from breast cancer make the condition an important target for preventive programmes, and it is time to take account of recent research and decide how best to capitalise on the opportunities it presents.