Proactive breast cancer risk assessment in primary care: a review based on the principles of screening

Abstract

In the UK, the National Institute for Health and Care Excellence (NICE) recommends that women at moderate or high risk of breast cancer be offered risk-reducing medication and enhanced breast screening/surveillance. In June 2022, NICE withdrew a statement recommending assessment of risk in primary care only when women present with concerns. This shift to the proactive assessment of risk substantially changes the role of primary care, in effect paving the way for a primary care-based screening programme to identify those at moderate or high risk of breast cancer. In this article, we review the literature surrounding proactive breast cancer risk assessment within primary care against the consolidated framework for screening. We find that risk assessment for women under 50 years currently satisfies many of the standard principles for screening. Most notably, there are large numbers of women at moderate or high risk currently unidentified, risk models exist that can identify those women with reasonable accuracy, and management options offer the opportunity to reduce breast cancer incidence and mortality in that group. However, there remain a number of uncertainties and research gaps, particularly around the programme/system requirements, that need to be addressed before these benefits can be realised.

Feasibility and acceptability of offering breast cancer risk assessment to general population women aged 30–39 years: a mixed-methods study protocol

“…A recent review determined that breast cancer risk assessment for women under 50 years currently satisfies many of the key principles for screening 20. However, uncertainties remain with respect to the optimal strategy for implementation and potential impact of the invitation process on health inequalities.…”

“…A recent review determined that breast cancer risk assessment for women under 50 years currently satisfies many of the key principles for screening. 20 However, uncertainties remain with respect to the optimal strategy for implementation and potential impact of the invitation process on health inequalities. The Breast CANcer Risk Assessment in Younger women (BCAN-RAY) case–control study (NCT05305963) aims to evaluate a comprehensive breast cancer risk assessment strategy among a diverse ethnic and socioeconomic population of women aged 30–39 years without a strong family history of breast cancer.…”

Multicancer screening test based on the detection of circulating non haematological proliferating atypical cells

“…Parallel to the development of LB applications in preventive medicine, AI was used to identify an increasing degree of health problems in various segments of the population for a novel cycle of screening programs, including the targeted screening and stratified screening [ 3 , 13 ].…”

Risk-Stratified Breast Cancer Screening in Malaysia: Challenges and Opportunities

“…Studies in the United States suggested that it is feasible to conduct a risk assessment of a patient during the time when a patient is waiting meet their doctor [ 61 , 62 ]. Coordination is needed regarding further genetic testing and the initiation of risk-reducing medication by specialists such as oncologists and breast surgeons [ 63 ]. On a more positive note, primary healthcare in Malaysia has been shown to provide comprehensive, coordinated, and continuity of care in private and public sectors [ 64 ].…”