title: Assessing individual breast cancer risk within the U.K. National Health Service Breast Screening Program: a new paradigm for cancer prevention.
abstract: The aim of this study is to determine breast cancer risk at mammographic screening episodes and integrate standard risk factors with mammographic density and genetic data to assess changing the screening interval based on risk and offer women at high risk preventive strategies. We report our experience of assessing breast cancer risk within the U.K. National Health Service Breast Screening Program using results from the first 10,000 women entered into the "Predicting Risk Of breast Cancer At Screening" study. Of the first 28,849 women attending for screening at fifteen sites in Manchester 10,000 (35%) consented to study entry and completed the questionnaire. The median 10-year Tyrer-Cuzick breast cancer risk was 2.65% (interquartile range, 2.10-3.45). A total of 107 women (1.07%) had 10-year risks 8% or higher (high breast cancer risk), with a further 8.20% having moderately increased risk (5%-8%). Mammographic density (percent dense area) was 60% or more in 8.3% of women. We collected saliva samples from 478 women for genetic analysis and will extend this to 18% of participants. At time of consent to the study, 95.0% of women indicated they wished to know their risk. Women with a 10-year risk of 8% or more or 5% to 8% and mammographic density of 60% or higher were invited to attend or be telephoned to receive risk counseling; 81.9% of those wishing to know their risk have received risk counseling and 85.7% of these were found to be eligible for a risk-reducing intervention. These results confirm the feasibility of determining breast cancer risk and acting on the information in the context of population-based mammographic screening.
authors.affiliation: Genesis Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, UK. gareth.evans@cmft.nhs.uk
authors.forename: D Gareth R
authors.initials: DG
authors.lastname: Evans
authors.forename: Jane
authors.initials: J
authors.lastname: Warwick
authors.forename: Susan M
authors.initials: SM
authors.lastname: Astley
authors.forename: Paula
authors.initials: P
authors.lastname: Stavrinos
authors.forename: Sarah
authors.initials: S
authors.lastname: Sahin
authors.forename: Sarah
authors.initials: S
authors.lastname: Ingham
authors.forename: Helen
authors.initials: H
authors.lastname: McBurney
authors.forename: Barbara
authors.initials: B
authors.lastname: Eckersley
authors.forename: Michelle
authors.initials: M
authors.lastname: Harvie
authors.forename: Mary
authors.initials: M
authors.lastname: Wilson
authors.forename: Ursula
authors.initials: U
authors.lastname: Beetles
authors.forename: Ruth
authors.initials: R
authors.lastname: Warren
authors.forename: Alan
authors.initials: A
authors.lastname: Hufton
authors.forename: Jamie C
authors.initials: JC
authors.lastname: Sergeant
authors.forename: William G
authors.initials: WG
authors.lastname: Newman
authors.forename: Iain
authors.initials: I
authors.lastname: Buchan
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.forename: Anthony
authors.initials: A
authors.lastname: Howell
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000517:prevention & control*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D009313:National Health Programs; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires