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Breast cancer: to screen based on risk or not

A new study looks at how a country’s health services affect the way in which a woman might experience risk-based breast screening.

Without a doubt, screening for breast cancer saves lives. However, scientists are still debating what amount of time between screenings is optimal to increase the benefits and at the same time reduce potential screening harms. One solution proposed is risk-stratified screening, where women at a higher risk of developing cancer receive additional screening while low-risk ones are screened less. A recent study published in the journal ‘Psychology & Health’ investigated the effects of healthcare context by comparing how women in two European countries experience risk-based breast screening. The study was part of an international trial supported by the EU-funded MyPeBS project that is assessing how effective risk-based breast cancer screening is compared to standard screening in detecting stage 2 or higher breast cancers.

In Europe, but not the same

The two countries studied were France and the United Kingdom (UK). Their different screening programmes and background healthcare circumstances allowed the researchers to examine risk-based screening through the eyes of those experiencing it. In France, routine breast screening takes place every 2 years. It targets women aged 50 to 74 years who undergo mammograms, clinical breast examinations and, if they have dense breasts, ultrasounds. In contrast, in the UK women aged 50 to 70 years are invited for routine screening using only a mammogram every 3 years. A total of 52 women (23 from the UK and 29 from France) underwent risk-based screening in the MyPeBS trial. They were divided into groups based on risk (low, average, high, very high), which determined future trial-related screening schedules and prevention options. The participants were between 40 and 70 years old when they joined the trial, although a higher proportion of French participants were younger, employed and had a university or college degree. “Across the dataset, women were positive about the possibility of a risk-stratified breast cancer screening programme such as they received in MyPeBS. Regardless of risk group, women described it as especially beneficial rather than having a mammogram only and it could lead to better breast cancer outcomes,” the authors report in the study. The study brought two overarching themes to the fore: the importance of supported risk communication and accessibility of risk management. While risk-based breast screening was generally viewed positively, higher-risk women felt more reassured when their appointments were with specialist healthcare professionals. “When absent, this resulted in reduced satisfaction with risk communication and greater uncertainty about its personal relevance.” This highlights the importance of implementing standardised procedures and ensuring support from specialists if a risk-stratified breast screening approach is ever implemented internationally. Women interested in taking part in the MyPeBS trial can find out more about it through this link. The project is also looking for investigators to inform women about the trial. The MyPeBS (International Randomized Study Comparing personalized, Risk-Stratified to Standard Breast Cancer Screening In Women Aged 40-70) project ends in 2026. For more information, please see: MyPeBS project website

Keywords

MyPeBS, breast, breast cancer, screening, breast cancer screening, risk-stratified screening, cancer, mammogram

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