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Breast Cancer Risk Assessment Tools for Stratifying Women into Risk Groups: A Systematic Review.

Louiza S Velentzis1,2, Victoria Freeman1,3, Denise Campbell1

  • 1The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW 2011, Australia.

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Summary
This summary is machine-generated.

Risk assessment tools for breast cancer screening show varied accuracy. While some identify high-risk women, calibration is inconsistent, and most tools have a high risk of bias.

Keywords:
breast cancer screeningrisk assessmentrisk prediction modelsrisk-based screening

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Area of Science:

  • Oncology
  • Epidemiology
  • Biostatistics

Background:

  • Balancing breast cancer screening benefits and harms is crucial.
  • Risk-stratified screening approaches are being explored.
  • Questionnaire-based risk assessment tools are a focus for this stratification.

Purpose of the Study:

  • To systematically review the accuracy of questionnaire-based risk assessment tools for breast cancer screening.
  • To evaluate the calibration and performance of these tools in identifying women at different risk levels.

Main Methods:

  • Systematic review of external validation studies (2008-2021) of asymptomatic women aged ≥40 years.
  • Included tools incorporated breast density and polygenic risk where available.
  • Assessed tool calibration, observed cancer rates by risk group, and risk of bias (PROBAST).

Main Results:

  • 13 studies evaluated 11 tools; Gail and Tyrer-Cuzick were most common.
  • No tool demonstrated consistent calibration across studies.
  • Breast density and polygenic risk scores did not improve calibration.
  • Most tools identified higher-risk groups, but few reliably identified lower-risk groups.
  • All assessed tools had a high risk of bias.

Conclusions:

  • Questionnaire-based risk assessment tools show potential in identifying women at higher or lower breast cancer risk.
  • Tool performance is highly dependent on the specific setting and population studied.
  • Further research is needed to improve the accuracy and reliability of these tools, especially in identifying lower-risk individuals.