Calls for more personalised breast cancer screening

24 March 2014

Data revealed at the 9th European Breast Cancer Conference suggests that providing more personalised breast cancer screening would improve early detection of cancers.
Professor Gareth Evans of the University of Manchester presented results from over 53,000 women receiving normal screening who were enrolled in the Predicting Risk Of breast Cancer At Screening (PROCAS) study.

The UK NHS Breast Screening Programme offers mammography every three years to all women aged 47-73, when average ten-year breast cancer risk is 2.4-3.5%. Researchers collected additional risk information from each participant including family history, lifestyle, breast density and in some cases genetic data.

Combining this information to produce more accurate risk prediction figures, they found that 2% of the women had a high ten-year breast cancer risk (8% or above) and nearly 28% had an above average risk (above 3.5%). The remainder were at low risk (average or lower). Not only did cancers occur at a significantly higher rate among the higher risk women in the course of the study, but they also had a greater proportion of more advanced cancers.

The researchers concluded that the high risk group of women ought to receive screening more frequently, ideally annually, to increase early detection of cancers. Prof Evans told the BBC that this would save the NHS an “enormous amount of money” as well as enabling women to take steps to reduce their risk, such as maintaining a healthy weight and moderating alcohol intake.

Comment: The final results from this ongoing study will carry greater weight than these interim findings, which nevertheless underline the potential benefits of more personalised approaches to disease prediction, prevention and diagnosis based on individual risk factors. The capacity to include genetic data in cancer risk prediction algorithms is likely to further refine such approaches. In time, the whole basis of screening programmes may have to shift so that individuals above a certain risk cut-off receive screening independent of age.

One difficulty posed by a holistic approach to personalised cancer screening would be deciding when individuals should receive assessment of their cancer risk as an entry-point for screening, since a small but significant number of women younger than 47 are likely to be at high risk. Possibly women might receive a preliminary risk assessment based on genetic risk at a young age, to identify those with increased familial (genetic) risk, with their genetic data retained for use in standard risk assessment in mid-life. It might depend on how far whole genome sequencing and genomic medicine becomes a routine element of healthcare provision. 

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