Risk-Based Breast Cancer Screening Can Improve the Balance of Screening Benefits to Harms

New study suggests screening women ages 50-74 with lower than average risk and low breast density every three years

Posted by Nicolien van Ravesteyn at 1:00 PM on Mar 30, 2021


Risk-based breast cancer screening can improve the balance of screening benefits to harms. Most research so far focused on strategies for screening women at higher than average risk, but few studies have assessed the harms and benefits for women at lower than average risk.

A study published in the Journal of the National Cancer Institute suggests that screening every three years (triennial screening) from age 50 to 74 years should be considered for women at lower than average risk with low density. This strategy reduces harms while maintaining a large part of the benefits. The study used three microsimulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET)and Breast Cancer Surveillance Consortium (BCSC) data to estimate the impact of different screening intervals on benefits and harms for low-risk women. Screening benefits decreased with decreasing risk and with lower breast density. For women with non-dense breast and a breast cancer risk that was at least 15% lower than average, there were few additional benefits when comparing screening every two vs. every three years. Among such women, the additional screening averted no more than 1 additional breast cancer death and gained no more than 16 life-years per 1000 women, while resulting in up to 232 more false-positives per 1000 women. The results contribute to the growing body of evidence that tailored screening has many advantages over age-based guidelines. 

An accompanying editorial states that this study “underscores the need for health systems to operationalize screening strategies based on women’s risk levels and preferences.”

Full text citation and Link: van Ravesteyn NT, Schechter CB, Hampton JM, Alagoz O, van den Broek JJ, Kerlikowske K, Mandelblatt JS, Miglioretti DL, Sprague BL, Stout NK, de Koning HJ, Trentham-Dietz A, Tosteson ANA from the Breast Cancer Surveillance Consortium and the Cancer Intervention and Surveillance Modeling Network. Trade-Offs Between Harms and Benefits of Different Breast Cancer Screening Intervals Among Low-Risk Women. Journal of the National Cancer Institute. 2021. Epub ahead of print. doi.org/10.1093/jnci/djaa218. [Link to Article]



Posted by: Nicolien van Ravesteyn