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Risk-based breast screening would ‘reduce over-diagnosis’

Friday July 6th, 2018

Targeted breast-screening programmes that are based on women’s risk levels would be cost-effective and reduce over-diagnosis, researchers said last night.

The researchers, from UCL, London, England, say that targeted breast screening that did not include low-risk women, could also maintain the benefits of screening.

Lead author Dr Nora Pashayan, of UCL Department of Applied Health Research, said: “Breast screening has both benefits and harms: it can reduce death from breast cancer in some women while others may have unnecessary diagnosis and treatment of breast cancer.

“Offering screening according to women’s risk level could improve the efficiency of the screening programme and reduce its harms.”

The research, published in JAMA Oncology, simulated three hypothetical cohorts of women, all aged 50 and free of cancer, followed up over 35 years.

Each cohort comprised 364,500 women, which was the 2009 population of women aged 50 in England and Wales.

The first group received no screening and the second received a mammography at age 50, and every three years thereafter, reflecting the NHS Breast Screening Programme (NHSBSP). However, for the third cohort, a risk estimation was carried out and only those with a risk score greater than the threshold risk, were offered screening every three years from 50 until aged 69.

The team used several accepted parameters, including predicted rates of age-specific breast cancer, breast cancer-specific mortality in screened and unscreened populations and the overdiagnosis estimate developed by the UK Independent Panel on Breast Cancer Screening.

NHS costs for the screening programme and costs of breast cancer treatment were used to model cost effectiveness of age-based and risk-based approaches to screening, as well as with no screening.

The benefit to harm balance was measured as the ratio of over diagnoses to breast cancer deaths prevented. The researchers simulated 100 different risk-based screening scenarios.

They found that risk-targeted screening, which does not include screening for women at the lowest 30% of the risk distribution, could result in 27% fewer overdiagnoses, 3% fewer breast cancer deaths avoided and cost the NHS £20,000 less.

Dr Pashayan said: “The take-up of breast screening is currently around 72%. If we maintain this take-up but in a way that women who would benefit more from screening attend and women who would be more harmed from screening are spared, then the cost-effectiveness and benefit to harm balance of the NHSBSP could be improved.”

She said with genotype analysis from cheek swabs, it may be possible to ensure more targeted screening.

Study co-author Professor Fiona Gilbert, from the University of Cambridge, added: “We need to change the model of delivery of breast screening and recognise that women are individuals with different risks and lifestyles. They should be offered screening tailored to their own profile.”

JAMA Oncology 5 July 2018

Tags: Cancer | NHS | UK News | Women's Health & Gynaecology

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