Since the advent of early breast cancer screening programs, there has been decreased mortality attributable to the disease. This has led to the implementation of global screening efforts. A survey of multiple randomized controlled trials has shown decreases in rates of breast cancer-related mortality range from 20% to 40% due to population-based screening efforts. However, screening efforts vary between countries, targeted age groups, and schedules of screening; in addition, they most commonly use a population-based approach, irrespective of personal risk of breast cancer. Allweis and colleagues examined the present population-based screening practices to identify limitations of these systems. They explored how both risk factors and risk assessment models for breast cancer are defined and reviewed the progress of clinical trials focused on personalized risk-adapted breast cancer screening.
There are various trials assessing personalized risk-adapted breast cancer screening. The researchers identified 3 ongoing, large-scale, randomized controlled clinical trials by surveying the MEDLINE and US National Library of Medicine (ClinicalTrials.gov) databases. The investigators included only studies in which women either underwent standard or personalized screening.
Risk stratification and screening modality methods varied in each of the trials. However, the overall goal of the investigation was to evaluate whether tailored risk-adapted screening practices can safely substitute for the current population-based method and lead to advanced-stage breast cancer diagnosis rates that are similar to those of current screening programs.
Upon reviewing the findings of these trials, the investigators concluded that targeting patients at high risk with more intensive screening may have benefits; it may help reduce the screening regimen for patients at low risk and diminish some of the drawbacks of screening (eg, false positives). By adopting a screening approach that is based on personal risk, rather than age-based population screening, this could mitigate false positives, overdiagnosis, and promote early diagnosis. Furthermore, there may be economic benefits seen in terms of cost-effectiveness. Overall, there may be some improvement on the performance of population-based screening methods.
The investigators noted that there may be some clear disadvantages of personalized screening; for example, due to the lack of uniform recommendations, there may be increased complexity. This may potentiate and lead to decreased compliance, and lead to confusion among patients and medical staff. To overcome the uncertainty, additional education would be required to train staff. Furthermore, systematic, periodic updating of each patient’s personal risk would require evaluations based on family history, risk-changing events, and ageing. Solutions to overcome these limitations include large-scale screening programs that integrate a dynamic risk assessment tool into each patient’s medical records and provide communication updates to patients and providers.
With the growth and standardization of electronic medical records and databases, the authors concluded that resolving and overcoming these challenges should not pose great difficulty. In the future, these findings may have an impact on population-based screening practices that currently exist. Personalized risk-adapted screening may establish a new category of screening that is appropriate for low-risk patients who require less-intensive screening.
Source
Allweis TM, Hermann N, Berenstein-Molho R, Guindy M. Personalized screening for breast cancer: rationale, present practices, and future directions. Ann Surg Oncol. 2021;28:4306-4317.
To sign up for our newsletter or print publications, please enter your contact information below.
