Breast cancer screening is ripe for change. We need to assess a woman’s risk – not just her age

Why We Need to Rethink Breast Cancer Screening in Australia

Australia’s BreastScreen program offers women regular mammograms based on their age. And this screening for breast cancer saves lives.

But much has changed since the program was introduced in the early 90s. Technology has developed, as has our knowledge of which groups of women might be at higher risk of breast cancer. So how we screen women for breast cancer needs to adapt.

Why does breast screening need to change?

Australia’s BreastScreen program was introduced in 1991 and offers women regular mammograms based on their age. Women aged 50–74 are targeted, but screening is available from the age of 40.

The program is key to Australia’s efforts to reduce the burden of breast cancer, providing more than a million screens each year.

Women who attend BreastScreen reduce their risk of dying from breast cancer by 49% on average.

Breast screening saves lives because it makes a big difference to find breast cancers early before they spread to other parts of the body.

Who’s at high risk, and how best to target them?

International evidence confirms it is possible to identify groups of women at higher risk of breast cancer. These include:

• women with denser breasts (where there’s more glandular and fibrous tissue than fatty tissue in the breasts) are more likely to develop breast cancer, and their cancers are harder to find on standard mammograms
• women whose mother, sisters, grandmother or aunts have had breast or ovarian cancer, especially if there are multiple relatives and the cancers occurred at young ages
• women who have been found to carry genetic mutations that lead to a higher risk of breast cancer (including women with multiple moderate risk mutations, as indicated by what’s known as a polygenic risk score)

The road ahead

This is what we have been working on, for Cancer Council Australia, as part of the ROZA Breast project.

This federally funded project has estimated and compared the expected outcomes and costs for a range of screening scenarios.

For each scenario we estimated the benefits (saving lives or less intense treatment) and harms (overdiagnosis and rates of investigations in women recalled for further investigation after a screening test who are found to not have breast cancer).

Conclusion

We’ve provided an evidence-based roadmap towards better screening for breast cancer. Now is the time to commit to this journey.

Frequently Asked Questions

Q: Why do we need to rethink breast cancer screening in Australia?

A: Technology has developed, as has our knowledge of which groups of women might be at higher risk of breast cancer. So how we screen women for breast cancer needs to adapt.

Q: Who is at higher risk of breast cancer?

A: Women with denser breasts, with a family history of breast or ovarian cancer, or who have been found to carry genetic mutations that lead to a higher risk of breast cancer are at higher risk.

Q: What are the benefits of risk-based breast cancer screening?

A: Risk-based screening can save lives, reduce the need for intensive treatment, and improve patient outcomes.

Q: What’s the next step?

A: A large-scale trial to test the feasibility, effectiveness, and affordability of risk-based breast cancer screening in Australia is needed. We also need to improve data collection and reporting, assess the best ways to assess women for their risk of breast cancer, and test different screening technologies.