ESR Essentials: screening for breast cancer - general recommendations by EUSOBI

Area of Science:

• Oncology
• Radiology
• Public Health

Background:

• Breast cancer is the most common cancer in women, with increasing incidence.
• Mammographic screening reduces mortality but has limitations like underdiagnosis and overdiagnosis.
• Current screening is age-based, not risk-stratified, impacting benefit-to-harm ratios.

Purpose of the Study:

• To evaluate the effectiveness of personalized breast cancer screening approaches.
• To compare risk-stratified screening with the current 'one-size-fits-all' mammography program.
• To explore the role of supplemental imaging and AI in improving screening outcomes.

Main Methods:

• Review of existing evidence on mammography, supplemental imaging (MRI, ultrasound), and AI in breast cancer screening.
• Analysis of limitations of current age-based screening protocols.
• Consideration of risk stratification based on individual risk factors and breast density.

Main Results:

• Mammography is effective in early diagnosis and reducing breast cancer mortality.
• Breast MRI is recommended for high-risk women and those with extremely dense breasts.
• AI shows promise in risk categorization and reducing interval cancers.

Conclusions:

• A personalized, risk-stratified approach to breast cancer screening can improve the benefit-to-harm ratio and cost-effectiveness.
• Mammography remains the mainstay, but supplemental MRI or ultrasound should be considered for specific populations.
• Shared decision-making between women and physicians is crucial for individualizing screening recommendations.