Jennifer Stone, The University of Western Australia

The way women are screened for breast cancer in Australia is changing.

According to a newly released review, this means moving away from screening largely based on someone’s age. Instead, screening would be tailored according to their individual risk.

This could mean using information such as breast density, family history, genetic tests, and/or artificial intelligence (AI) to identify and target those at increased risk of breast cancer.

But any changes to Australia’s long-running BreastScreen program won’t happen straight away. They’ll be phased in over the next ten years.

So what might this mean for women who may, unknowingly, be at increased risk? This is what we know so far.

What’s all this talk of ‘risk’?

Screening based on which category of risk a woman is in personalises the type and frequency of imaging to find cancer early and improve breast cancer outcomes. This is known as risk-stratified screening.

But currently, risk-stratification in BreastScreen programs is limited to recommendations for women with a significant family history of breast and/or ovarian cancer to be screened every year rather than every two years.

We know a lot about what makes someone at greater risk of developing breast cancer. But not all of this has been translated into practice. This means there have been fewer opportunities to manage an individual’s risk, find cancer early, and save lives.

How can we use what we know?

1. Dense breasts

One of the strongest and most common risk factors for breast cancer is breast density, the white areas on a mammogram that represent fibroglandular tissue. Women with dense breasts are at significantly increased risk of developing breast cancer and of a cancer going undetected at screening.

BreastScreen recommends all women be notified of their breast density at the time of screening. It also released guidance for GPs when consulting women with dense breasts.

However, questions remain about how best to communicate risk to women with dense breasts and whether they can access extra imaging, if it’s available. This might include 3D mammography, contrast-enhanced mammography and MRI.

2. Family history and genetic tests

Online risk assessment tools combine breast density with other information about breast cancer risk – such as family history and genetic test results – to calculate a woman’s individual risk. These include iPrevent, which women can use, then discuss the results with their GP, and CanRisk, which is designed for health professionals.

Both can inform discussions about the best way to manage an individual’s risk of breast cancer.

The results of genetic tests can be used to calculate an individual’s risk of breast cancer.

For example, we could use the presence of multiple gene variants to give an overall “polygenic risk score” to identify those at increased risk. This could be particularly useful for identifying younger women at increased risk who could benefit from earlier screening.

3. How about AI?

AI could be used to help interpret mammography imaging to help detect cancer. It could also help predict the future risk of disease.

This could reduce radiologists’ workloads and work out who to recall for further assessment.

An AI model trained using Australian data is currently being trialled in BreastScreen Victoria, and soon will be in South Australia.

What we don’t know

Unfortunately, the pathways to obtain and use much of this risk information have not yet been developed.

We need to use the latest methods of predicting risk and the latest screening technologies. We also need to work with consumers and stakeholders to co-design clear and consistent pathways to manage people in different risk categories.

Pilot studies are then needed to test the acceptability and feasibility of these pathways before large-scale implementation.

We also need to find effective ways to communicate individual risk to women and their health professionals.

We expect all this to take place and be implemented in stages over the next ten years.

In the meantime, women are recommended to have their next mammogram at BreastScreen when it’s next due. Women over 40 can have a free mammogram every two years and women aged 50–74 are invited to screen.

Women are also recommended to talk to their doctor regularly about their breast health, and to see their doctor as soon as possible if they have any new symptoms. These include breast lumps, nipple discharges, changes in the breast shape or in the skin of the breast, or new and ongoing breast pain.

Jennifer Stone, Principal Research Fellow, School of Population and Global Health, The University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.