Towards personalized screening: Cumulative risk of breast cancer screening outcomes in women with and without a first‐degree relative with a history of breast cancer

• Published in: International journal of cancer 2016-04, Vol.138 (7), p.1619-1625
• Main Authors: Ripping, Theodora Maria, Hubbard, Rebecca A., Otten, Johannes D.M., den Heeten, Gerard J., Verbeek, André L.M., Broeders, Mireille J.M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - genetics; Cancer; Early Detection of Cancer - methods; false positive; False Positive Reactions; family history; Family medical history; Female; Genetic Predisposition to Disease; Humans; interval cancer; Mammography; Medical research; Middle Aged; Netherlands; Pedigree; Risk Factors; screening; screen‐detected
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.29912

Several reviews have estimated the balance of benefits and harms of mammographic screening in the general population. The balance may, however, differ between individuals with and without family history. Therefore, our aim is to assess the cumulative risk of screening outcomes; screen‐detected breast cancer, interval cancer, and false‐positive results, in women screenees aged 50–75 and 40–75, with and without a first‐degree relative with a history of breast cancer at the start of screening. Data on screening attendance, recall and breast cancer detection were collected for each woman living in Nijmegen (The Netherlands) since 1975. We used a discrete time survival model to calculate the cumulative probability of each major screening outcome over 19 screening rounds. Women with a family history of breast cancer had a higher risk of all screening outcomes. For women screened from age 50–75, the cumulative risk of screen‐detected breast cancer, interval cancer and false‐positive results were 9.0, 4.4 and 11.1% for women with a family history and 6.3, 2.7 and 7.3% for women without a family history, respectively. The results for women 40–75 followed the same pattern for women screened 50–75 for cancer outcomes, but were almost doubled for false‐positive results. To conclude, women with a first‐degree relative with a history of breast cancer are more likely to experience benefits and harms of screening than women without a family history. To complete the balance and provide risk‐based screening recommendations, the breast cancer mortality reduction and overdiagnosis should be estimated for family history subgroups. What's new? Breast cancer screening is shifting away from a one‐size‐fits‐all approach, where age determines mammography frequency, to personalized approaches, which balance the benefits and harms of mammographic screening. This study shows that women with a first‐degree family history of breast cancer are more likely to have favorable and unfavorable screening outcomes than women without a family history of the disease. Women with a family history had a higher chance of small invasive cancers being detected but also were at increased risk of interval cancers and false‐positives. The findings emphasize the need for careful benefit‐harm assessment in mammographic screening.