Toward Risk-Based Breast Cancer Screening

Abstract

EditorialsMay 2021Toward Risk-Based Breast Cancer ScreeningKarla Kerlikowske, MD and Kirsten Bibbins-Domingo, MD, PhDKarla Kerlikowske, MDUniversity of California, San Francisco San Francisco, California and Kirsten Bibbins-Domingo, MD, PhDUniversity of California, San Francisco San Francisco, CaliforniaAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-0398 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Evidence shows that risk-based versus age-based screening improves the balance of benefits and harms of screening for breast cancer (1–3). How best to implement risk-based screening for breast cancer is a topic of active research. This research has incorporated risk factors like family history of breast cancer, patient history of breast biopsy, and breast density (1–3). High breast density poses a particular challenge because it is common and both increases breast cancer risk and decreases the sensitivity of mammography for the detection of breast cancer. Further, breast imaging is necessary to measure breast density, so identifying the optimal time to ...References1. Schousboe JT, Kerlikowske K, Loh A, et al. Personalizing mammography by breast density and other risk factors for breast cancer: analysis of health benefits and cost-effectiveness. Ann Intern Med. 2011;155:10-20. doi:10.7326/0003-4819-155-1-201107050-00003 LinkGoogle Scholar2. Vilaprinyo E, Forné C, Carles M, et al; Interval Cancer (INCA) Study Group. Cost-effectiveness and harm-benefit analyses of risk-based screening strategies for breast cancer. PLoS One. 2014;9:e86858. [PMID: 24498285] doi:10.1371/journal.pone.0086858 CrossrefMedlineGoogle Scholar3. Mandelblatt JS, Stout NK, Schechter CB, et al. Collaborative modeling of the benefits and harms associated with different U.S. breast cancer screening strategies. Ann Intern Med. 2016;164:215-25. doi:10.7326/M15-1536 LinkGoogle Scholar4. Shih YTC, Dong W, Xu Y, et al. Incorporating baseline breast density when screening women at average risk for breast cancer. A cost-effectiveness analysis. Ann Intern Med. 2021;174:602-12. doi:10.7326/M20-2912 Google Scholar5. Melnikow J, Fenton JJ, Whitlock EP, et al. Supplemental screening for breast cancer in women with dense breasts: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164:268-78. doi:10.7326/M15-1789 LinkGoogle Scholar6. Trentham-Dietz A, Kerlikowske K, Stout NK, et al; Breast Cancer Surveillance Consortium and the Cancer Intervention and Surveillance Modeling Network. Tailoring breast cancer screening intervals by breast density and risk for women aged 50 years or older: collaborative modeling of screening outcomes. Ann Intern Med. 2016;165:700-712. doi:10.7326/M16-0476 LinkGoogle Scholar7. Kerlikowske K, Zhu W, Tosteson AN, et al; Breast Cancer Surveillance Consortium. Identifying women with dense breasts at high risk for interval cancer: a cohort study. Ann Intern Med. 2015;162:673-81. doi:10.7326/M14-1465 LinkGoogle Scholar8. Tice JA, Cummings SR, Smith-Bindman R, et al. Using clinical factors and mammographic breast density to estimate breast cancer risk: development and validation of a new predictive model. Ann Intern Med. 2008;148:337-47. doi:10.7326/0003-4819-148-5-200803040-00004 LinkGoogle Scholar9. Engmann NJ, Golmakani MK, Miglioretti DL, et al; Breast Cancer Surveillance Consortium. Population-attributable risk proportion of clinical risk factors for breast cancer. JAMA Oncol. 2017;3:1228-1236. [PMID: 28152151] doi:10.1001/jamaoncol.2016.6326 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of California, San Francisco San Francisco, CaliforniaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-0398.Corresponding Author: Kirsten Bibbins-Domingo, MD, PhD, University of California, San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA 94158; e-mail, kirsten.[email protected]edu.Current Author Addresses: Dr. Kerlikowske: University of California, San Francisco, VAMC (111A1), 4150 Clement Street, San Francisco, CA 94121.Dr. Bibbins-Domingo: University of California, San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA 94158.This article was published at Annals.org on 9 February 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIncorporating Baseline Breast Density When Screening Women at Average Risk for Breast Cancer Ya-Chen Tina Shih , Wenli Dong , Ying Xu , Ruth Etzioni , and Yu Shen Metrics Cited byStudy protocol comparing the ethical, psychological and socio-economic impact of personalised breast cancer screening to that of standard screening in the "My Personal Breast Screening" (MyPeBS) randomised clinical trial May 2021Volume 174, Issue 5Page: 710-711KeywordsBiopsyBreast cancerBreast cancer screeningCancer screeningDisclosureMammographyMedical risk factorsRadiologistsResearch designScreening guidelines ePublished: 9 February 2021 Issue Published: May 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

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