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.
This could reduce radiologists’ workloads and work out who to recall for further assessment.
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.
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.
What’s all this talk of ‘risk’?
AI could be used to help interpret mammography imaging to help detect cancer. It could also help predict the future risk of disease.
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.
We also need to find effective ways to communicate individual risk to women and their health professionals.
How can we use what we know?
The results of genetic tests can be used to calculate an individual’s risk of breast cancer.
We expect all this to take place and be implemented in stages over the next ten years.
Both can inform discussions about the best way to manage an individual’s risk of breast cancer.
3. How about AI?
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.
Pilot studies are then needed to test the acceptability and feasibility of these pathways before large-scale implementation.
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.
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.
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.
Unfortunately, the pathways to obtain and use much of this risk information have not yet been developed.
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.
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.
1. Dense breasts
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.
What we don’t know
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.
So what might this mean for women who may, unknowingly, be at increased risk? This is what we know so far.
2. Family history and genetic tests
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.
Read more:
Having dense breasts is linked to cancer. But advice about breast density can depend on where you live
An AI model trained using Australian data is currently being trialled in BreastScreen Victoria, and soon will be in South 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.
