Harms of Restrictive Risk-Based Mammographic Breast Cancer Screening.

Area of Science:

• Radiology and Medical Imaging
• Oncology
• Public Health

Background:

• Mammographic screening is crucial for early breast cancer detection.
• Current screening guidelines vary, with some focusing on risk-based approaches.
• The effectiveness of restrictive risk-based screening versus population-based screening requires evaluation.

Purpose of the Study:

• To assess if restrictive risk-based mammographic screening misses breast cancers detectable by population-based screening.
• To identify patient demographics and characteristics associated with screen-detected breast cancers.

Main Methods:

• Retrospective analysis of 552 screen-detected breast cancers in 533 patients (2011-2014).
• Data reviewed included patient history, pathology, cancer characteristics, breast density, and mammographic findings.
• Risk factors evaluated were family history of breast cancer and dense breast tissue.

Main Results:

• A significant proportion of cancers were detected in women without a family history of breast cancer (75.6%) or dense breasts (56%).
• Younger women (40-49 years) without family history or dense breasts also had screen-detected cancers.
• Minimal cancers (ductal carcinoma in situ and small invasive cancers) constituted a substantial portion of detections.

Conclusions:

• Many breast cancers are detected in women who do not meet restrictive risk-based screening criteria.
• Relying solely on risk-based screening may lead to delayed diagnosis for a considerable number of women.
• Population-based screening strategies may be necessary to ensure comprehensive early detection of breast cancer.