New Breast Cancer Screening Model Improves Detection

Personalized screening for breast cancer could improve detection of the disease and reduce unnecessary investigations. A large study from the United States suggests that personal risk assessment can change breast cancer screening.

New data suggest that tailoring breast cancer screening to each woman’s individual risk could lead to more effective detection of the disease and avoidance of unnecessary testing. Instead of a uniform approach, applied to everyone based on age, the researchers propose a model that takes into account the real differences in risk between people.

A pioneering study in the United States shows that breast cancer screening tailored to individual risk is more effective than routine annual mammography for all women. This strategy reduces the probability of detecting cancers in advanced stages and ensures, at the same time, an appropriate level of investigations for each person.

results is based on data from approximately 46,000 women included in the first phase of the WISDOM (Women Informed to Screen Depending on Measures of Risk) study, a project coordinated by the University of California, San Francisco (UCSF). The analysis points to the need for a shift in screening guidelines based almost exclusively on age to a model that begins with a detailed assessment of individual risk.

The study, published in December, in the journal JAMA and presented at the San Antonio Breast Cancer Symposium, shows that the risk of breast cancer varies considerably from one person to another, contrary to the assumption that has long been the basis of screening recommendations. The researchers point out that the risk assessment included genetic, biological and lifestyle factors.

Within WISDOM, the participants were divided into four risk categories, using validated models that took into account age, genetic profile, lifestyle, medical history and breast density.

About 26% of women in the low-risk category were advised to delay screening until age 50 or until the smart algorithm indicated a risk equivalent to that of a 50-year-old woman.

Those with medium risk, representing 62% of the participants, received the screening recommendation once every two years. Annual screening was indicated for 8% of women, considered at high risk, and the 2% in the highest risk category were investigated twice a year, alternatively by mammography and magnetic resonance imaging (MRI), regardless of age.

Women in the high and very high risk categories also received personalized recommendations to reduce the risk of breast cancer. These included access to an online breast health decision-making tool and direct advice from a specialist. Recommendations covered changes in diet and physical activity, as well as consideration of risk-reducing medication, where appropriate.

The risk-based approach did not lead to an increase in the number of cancers diagnosed in advanced stages. In addition, women who did not want to be automatically assigned to one of the screening strategies could participate in an observational group, in which they chose their own screening method. Of these, 89% opted for risk-based screening, suggesting a clear preference for this strategy.

Another important result of the study was related to genetic testing. The researchers found that 30 percent of women who had genetic variants associated with an increased risk of breast cancer reported no family history of the disease. According to current clinical guidelines, these individuals would not normally be eligible for genetic testing.

In addition to the well-known genetic variants, such as BRCA1 and BRCA2, the study also analyzed other genetic changes, which, combined in a polygenic risk score, can improve the estimation of the probability of breast cancer occurrence. The integration of these data led to the reclassification of approximately 12–14% of the participants in another risk category.

The WISDOM study, initiated in 2016, has so far included over 80,000 women. In recent years, researchers have begun to recruit participants over the age of 30, in order to identify in time people at risk of developing aggressive forms of breast cancer associated with certain genetic variants.

Research continues through the WISDOM 2.0 study, which aims to improve risk assessment and provide personalized screening and prevention options to improve the safety and effectiveness of breast cancer screening strategies.

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