Advanced Versus Invasive Breast Cancer Risk in a Screening Population: Implications for Risk-based Prevention and...

Area of Science:

• Oncology
• Radiology
• Preventive Medicine

Background:

• Current breast cancer risk models primarily use invasive breast cancer risk.
• The Breast Cancer Surveillance Consortium (BCSC) developed a new model for advanced breast cancer risk (stage II+).
• This advanced model identifies women at high risk despite regular mammography screening.

Purpose of the Study:

• To compare the characteristics of women identified by advanced versus invasive breast cancer risk models.
• To inform risk-based intervention strategies for diverse patient populations.

Main Methods:

• A cross-sectional study analyzed data from 756,971 women aged 40-74 undergoing mammography.
• Cumulative 6-year advanced breast cancer risk and 5-year invasive breast cancer risk were calculated using BCSC models.
• Risk scores were stratified by age, race/ethnicity, breast density, and BMI.

Main Results:

• The correlation between advanced and invasive risk scores was 0.75.
• Approximately 32% of women fell into the intermediate/high risk category for both advanced and invasive cancer.
• Significant differences emerged: 35% of high-risk invasive cases had low advanced risk, and 16% of low-risk invasive cases had high advanced risk.
• Women with intermediate/high advanced cancer risk were more likely to be younger (17.5% aged 40-49), Black (25.7%), have dense breasts (69.7%), and be overweight/obese (81.1%) compared to those with high invasive risk.

Conclusions:

• Substantial demographic and clinical differences exist between women identified by advanced versus invasive breast cancer risk models.
• The advanced cancer risk model is vital for identifying specific subgroups, including younger women, Black women, those who are overweight/obese, or have dense breasts, who may benefit from targeted risk-based interventions.