Selection of women at high risk of breast cancer for initial screening

Selective breast cancer screening refers to the intentional restriction of screening to only a high-risk subgroup of the total population of women at risk. Using data from the Canadian National Breast Screening Study, we explored methods of defining such subgroups. Discriminants were based on risk factor information collected prior to screening and were constructed using a training group of 77 cases and 400 controls. They were then tested on a separate group of 38 cases and 200 controls. Both simple risk factor counts and logistic models were utilized and separate analyses were performed for pre- and post-menopausal women. Using a logistic model, we were able to define a high-risk subgroup encompassing less than 40% of the test controls and over 85% of the test cases. Such a selection strategy, if implemented, might reduce initial visit mammography rates by up to 60% with only a small reduction in case detection. Other uses as determining the optimal age for initiation of screening are also discussed.