Implementation of risk stratified breast cancer screening: Lessons learned from the PERSPECTIVE I&I Project

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• Professor Jacques Simard, PhD, FRSC, FCAHS
• Wednesday 28 February 2024, 14:30-15:30
• Dorothy & Thomas Room, Strangeways Research Lab.

If you have a question about this talk, please contact Sarah Gordon.

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In Canada, women ages 50 to 74 are recommended to have a mammogram every 2 to 3 years. Risk-stratified breast screening has been proposed as a strategy to overcome the limitations of age-based screening. Taking advantage of risk stratification tools developed as part of the first phase of PERSPECTIVE , the Personalized Risk Assessment for Prevention and Early Detection of Breast Cancer: Integration and Implementation (PERSPECTIVE I&I) study aims to produce evidence on the feasibility, acceptability, adoption and cost-effectiveness of a screening approach based on individual risk in order to generate the first Canadian real-world evidence supporting implementation of risk-stratified screening (Brooks et al. J Pers Med. 2021; 11(6): 511).

The study recruited unaffected women aged 40-69 years old who had a mammogram. The comprehensive CanRisk prediction tool (Lee et al. Genetics in Medicine, 2019, 21(8) 1708-1718; www.canrisk.org) was used to estimate a 10-year risk of breast cancer. The resulting risk estimates were then stratified into 3 categories using absolute risk thresholds that vary depending on the age of the participants (Pashayan et al. J Pers Med.2021 11 (9): 916) namely: average risk, higher than average risk and high risk, which correspond to a residual lifetime risk of breast cancer (30 to 80 years) of

Results demonstrates the feasibility of risk assessment for stratified population-level screening, but highlights some potential challenges and considerations for recruitment and data collection. Implementation should incorporate an equity lens to ensure cancer screening disparities are not widened. This study also indicates that risk-based screening is acceptable to women and that there is no evidence of adverse psychological outcomes of stratified breast cancer risk communication up to one year after disclosure.

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