title: Can the breast screening appointment be used to provide risk assessment and prevention advice?
abstract: Breast cancer risk is continuing to increase across all societies with rates in countries with traditionally lower risks catching up with the higher rates in the Western world. Although cure rates from breast cancer have continued to improve such that absolute numbers of breast cancer deaths have dropped in many countries despite rising incidence, only some of this can be ascribed to screening with mammography, and debates over the true value of population-based screening continue. As such, enthusiasm for risk-stratified screening is gaining momentum. Guidelines in a number of countries already suggest more frequent screening in certain higher-risk (particularly, familial) groups, but this could be extended to assessing risks across the population. A number of studies have assessed breast cancer risk by using risk algorithms such as the Gail model, Tyrer-Cuzick, and BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm), but the real questions are when and where such an assessment should take place. Emerging evidence from the PROCAS (Predicting Risk Of Cancer At Screening) study is showing not only that it is feasible to undertake risk assessment at the population screening appointment but that this assessment could allow reduction of screening in lower-risk groups in many countries to 3-yearly screening by using mammographic density-adjusted breast cancer risk.
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK. gareth.evans@cmft.nhs.uk.|Genomic Medicine, Manchester Academic Health Science Centre, University of Manchester, Central Manchester Foundation Trust, St. Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK. gareth.evans@cmft.nhs.uk.|Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Christie Hospital, Wilmslow Road, Withington, Manchester, M20 4BX, UK. gareth.evans@cmft.nhs.uk.
authors.forename: D Gareth
authors.initials: DG
authors.lastname: Evans
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.|Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Christie Hospital, Wilmslow Road, Withington, Manchester, M20 4BX, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Howell
mesh_terms: D000367:Age Factors; D001071:Appointments and Schedules; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening; D008962:Models, Theoretical; D015203:Reproducibility of Results; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013997:Time Factors