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Mammography screening 2.0 - translating risk adapted screening into clinical practice
Mammography screening 2.0 - translating risk adapted screening into clinical practice
There has been a lot of controversy about the current mammography screening program. Screening recommendations for breast cancer in Germany are currently based solely on age and gender of an individual, despite the fact that additional genetic and non-genetic factors are known to influence cancer risk. Recent breast cancer risk models include these factors. They would allow the implication of a risk adapted screening approach, “Mammography Screening 2.0”. On the one hand there is a need to intensify diagnostic procedures for women at higher risk; on the other hand it is desired to avoid unnecessary diagnostic procedures in women who are unlikely to develop breast cancer. The aim is to improve the efficiency of the screening program and to help guide screening decisions by patients’ individual risk profiles and preferences. However, the implementation of such a strategy faces new challenges, such as the choice of the adequate prediction model, the interpretation of the results, and the ways to communicate the risks. We could show that currently used risk models, such as IBIS and BOADICEA, are well calibrated and conclusively already provide a useful perspective for individualized screening as they perform more effectively than considering age alone. Our ultimate goal is to categorize women according to their risk of breast cancer as accurately as possible, based on their profile of genetic and non-genetic risk factors, and to recommend a more individualized screening program. However, at the moment we do not have an international agreement how best to define for breast cancer the “high risk” group. We recommend that physicians use time periods of briefer duration, such as 5 or 10-year risks to identify women at high risk. Appropriate risk communication in Mammography Screening 2.0 will present a new but interesting challenge for physicians. There is a need to implement shared decision-making in routine medical practice, and also a need for fundamental schemes for risk communication. In conclusion our research shows that an individualized risk adapted screening strategy is feasible and of advantage in clinical practice. Our research could contribute to the evidence required to overcome any barriers associated with replacing the current “all inclusive” age related screening guidelines with a more focused individualized approach, which requires medical counseling.
mammography screening, breast cancer, risk adpated screening
Quante, Anne
2018
English
Universitätsbibliothek der Ludwig-Maximilians-Universität München
Quante, Anne (2018): Mammography screening 2.0 - translating risk adapted screening into clinical practice. Habilitationsschrift, LMU München: Faculty of Medicine
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Abstract

There has been a lot of controversy about the current mammography screening program. Screening recommendations for breast cancer in Germany are currently based solely on age and gender of an individual, despite the fact that additional genetic and non-genetic factors are known to influence cancer risk. Recent breast cancer risk models include these factors. They would allow the implication of a risk adapted screening approach, “Mammography Screening 2.0”. On the one hand there is a need to intensify diagnostic procedures for women at higher risk; on the other hand it is desired to avoid unnecessary diagnostic procedures in women who are unlikely to develop breast cancer. The aim is to improve the efficiency of the screening program and to help guide screening decisions by patients’ individual risk profiles and preferences. However, the implementation of such a strategy faces new challenges, such as the choice of the adequate prediction model, the interpretation of the results, and the ways to communicate the risks. We could show that currently used risk models, such as IBIS and BOADICEA, are well calibrated and conclusively already provide a useful perspective for individualized screening as they perform more effectively than considering age alone. Our ultimate goal is to categorize women according to their risk of breast cancer as accurately as possible, based on their profile of genetic and non-genetic risk factors, and to recommend a more individualized screening program. However, at the moment we do not have an international agreement how best to define for breast cancer the “high risk” group. We recommend that physicians use time periods of briefer duration, such as 5 or 10-year risks to identify women at high risk. Appropriate risk communication in Mammography Screening 2.0 will present a new but interesting challenge for physicians. There is a need to implement shared decision-making in routine medical practice, and also a need for fundamental schemes for risk communication. In conclusion our research shows that an individualized risk adapted screening strategy is feasible and of advantage in clinical practice. Our research could contribute to the evidence required to overcome any barriers associated with replacing the current “all inclusive” age related screening guidelines with a more focused individualized approach, which requires medical counseling.