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Personalized screening based on risk and density: prevalence data from the RIBBS study.

Francesca Caumo1, Gisella Gennaro2, Alessandra Ravaioli3

  • 1Breast Radiology Unit, Department of Imaging and Radiotherapy, Veneto Institute of Oncology (IOV) IRCCS, Via Gattamelata 64, 35128, Padua, Italy.

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The Risk-Based Breast Screening (RIBBS) study shows a personalized approach using digital breast tomosynthesis (DBT) can identify higher breast cancer (BC) prevalence in at-risk women. This tailored screening strategy is feasible and identifies specific subpopulations for targeted screening.

Keywords:
Breast cancerBreast densityCancer screeningDigital breast tomosynthesisRisk assessment

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Area of Science:

  • Oncology
  • Radiology
  • Public Health

Background:

  • Current breast cancer (BC) screening guidelines often use a one-size-fits-all approach.
  • Personalized screening models aim to optimize detection and reduce overdiagnosis.
  • Digital breast tomosynthesis (DBT) offers improved visualization of dense breast tissue.

Purpose of the Study:

  • To evaluate the prevalence screening results of the Risk-Based Breast Screening (RIBBS) study.
  • To assess a personalized screening model using DBT for women aged 45-49.
  • To compare advanced BC incidence reduction with tailored screening versus annual mammography.

Main Methods:

  • Enrolled 10,269 women aged 45 in an interventional cohort (January 2020-December 2021).
  • Utilized DBT and a BC risk questionnaire for risk stratification into five subgroups.
  • Compared screening performance against a control cohort of 43,838 women undergoing annual digital mammography (DM).

Main Results:

  • Intermediate-risk groups (IR-LD, IR-HD) showed significantly higher BC prevalence (4.9- and 4.6-fold) compared to low-risk, low-density (LR-LD).
  • Higher prevalence of pT1c tumors (7.1-fold) was observed in intermediate-risk groups.
  • The interventional cohort had a lower recall rate (0.5) but increased prevalence of DCIS (2.9), pT1c (2.3), and grade 3 tumors (2.4).

Conclusions:

  • Prevalence screening confirmed the feasibility of DBT and supplemental ultrasound (US) in high-density subgroups.
  • Stratification criteria effectively identified subpopulations with varying BC prevalence.
  • Increasing detection of early-stage tumors (pT1c) is necessary, but not sufficient, for reducing advanced BC incidence.