Translating absolute risk of breast cancer into screening frequency: a framework to guide practice

Current precision mammography screening trials use heterogeneous risk models, risk strata, and screening intervals, with no consensus on how absolute breast cancer risk should translate into screening frequency. A standardized, risk-model-agnostic approach could improve consistency in trial design and facilitate broader clinical implementation. To develop and evaluate a risk-model-agnostic framework that maps guideline-defined absolute breast cancer risk cut points to screening intervals that can guide the design of future personalized screening strategies and translate smoothly to routine clinical practice.

Screening interval and frequency derived from the absolute risk of breast cancer in US women is the main outcome.

The framework yielded a gradient of estimated screening intervals that scaled with absolute risk: annual (2%-3%); annual with supplemental imaging/counseling (≥3%); biennial (1%-2%); and potentially less frequently. When compared with ongoing intervention trials, screening intervals assigned by trials varied widely and were not uniformly aligned with absolute-risk levels, underscoring the lack of standardized mapping between risk and screening intensity.

A risk-model-agnostic framework based on absolute-risk cut points can provide a transparent and standardized method for specifying screening intervals in personalized mammography screening. This approach may improve consistency in future intervention trials and facilitate equitable implementation of precision screening across population settings.