Five-Year Absolute Risk-Based and Age-Based Breast Cancer Screening in the US

Area of Science:

• Oncology
• Radiology
• Preventive Medicine
• Biostatistics

Background:

• Current mammography screening guidelines are age-based, not accounting for individual breast cancer risk.
• A personalized, risk-based approach may optimize screening effectiveness and reduce unnecessary recalls.

Purpose of the Study:

• To compare the effectiveness of risk-based mammography screening strategies against traditional age-based strategies.
• To evaluate the impact on breast cancer mortality and false-positive screening recalls.

Main Methods:

• A decision-analytic model using two Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer models.
• Simulated US women aged 40+ without prior breast cancer history, using digital breast tomosynthesis.
• Compared 47 risk-based strategies and 3 age-based strategies against a no-screening scenario.

Main Results:

• Nine risk-based strategies averted as many or more breast cancer deaths compared to biennial age-based screening (ages 40-74).
• Risk-based strategies reduced false-positive recalls by 8%-23% compared to age-based screening.
• A specific risk-based strategy demonstrated 6% more deaths averted and 13% fewer false positives.

Conclusions:

• Population risk-based mammography screening offers comparable or superior benefits to age-based screening.
• Risk-based screening significantly reduces false-positive recalls, enhancing patient care.
• Personalized, risk-based screening is a promising cornerstone for future breast cancer prevention strategies.