title: Towards personalized screening: Cumulative risk of breast cancer screening outcomes in women with and without a first-degree relative with a history of breast cancer.
abstract: Several reviews have estimated the balance of benefits and harms of mammographic screening in the general population. The balance may, however, differ between individuals with and without family history. Therefore, our aim is to assess the cumulative risk of screening outcomes; screen-detected breast cancer, interval cancer, and false-positive results, in women screenees aged 50-75 and 40-75, with and without a first-degree relative with a history of breast cancer at the start of screening. Data on screening attendance, recall and breast cancer detection were collected for each woman living in Nijmegen (The Netherlands) since 1975. We used a discrete time survival model to calculate the cumulative probability of each major screening outcome over 19 screening rounds. Women with a family history of breast cancer had a higher risk of all screening outcomes. For women screened from age 50-75, the cumulative risk of screen-detected breast cancer, interval cancer and false-positive results were 9.0, 4.4 and 11.1% for women with a family history and 6.3, 2.7 and 7.3% for women without a family history, respectively. The results for women 40-75 followed the same pattern for women screened 50-75 for cancer outcomes, but were almost doubled for false-positive results. To conclude, women with a first-degree relative with a history of breast cancer are more likely to experience benefits and harms of screening than women without a family history. To complete the balance and provide risk-based screening recommendations, the breast cancer mortality reduction and overdiagnosis should be estimated for family history subgroups.
authors.affiliation: Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Theodora Maria
authors.initials: TM
authors.lastname: Ripping
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Hubbard
authors.affiliation: Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Johannes D M
authors.initials: JD
authors.lastname: Otten
authors.affiliation: Dutch Reference Centre for Screening, Nijmegen, the Netherlands.|Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: den Heeten
authors.affiliation: Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: André L M
authors.initials: AL
authors.lastname: Verbeek
authors.affiliation: Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.|Dutch Reference Centre for Screening, Nijmegen, the Netherlands.
authors.forename: Mireille J M
authors.initials: MJ
authors.lastname: Broeders
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics; D055088:Early Detection of Cancer / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009426:Netherlands; D010375:Pedigree; D012307:Risk Factors
keywords: breast cancer; false positive; family history; interval cancer; mammography; screen-detected; screening