title: Recommendations on breast cancer screening and prevention in the context of implementing risk stratification: impending changes to current policies.
abstract: In recent years, risk stratification has sparked interest as an innovative approach to disease screening and prevention. The approach effectively personalizes individual risk, opening the way to screening and prevention interventions that are adapted to subpopulations. The international perspective project, which is developing risk stratification for breast cancer, aims to support the integration of its screening approach into clinical practice through comprehensive tool-building. Policies and guidelines for risk stratification-unlike those for population screening programs, which are currently well regulated-are still under development. Indeed, the development of guidelines for risk stratification reflects the translational aspects of perspective. Here, we describe the risk stratification process that was devised in the context of perspective, and we then explain the consensus-based method used to develop recommendations for breast cancer screening and prevention in a risk-stratification approach. Lastly, we discuss how the recommendations might affect current screening policies.
authors.affiliation: Montreal, QC: Centre of Genomics and Policy, Department of Human Genetics, McGill University (Gagnon, Lévesque, Knoppers); Quebec Breast Cancer Foundation [Dumais (observing member)]; Sir Mortimer B. Davis Jewish General Hospital and McGill University Health Centre (Foulkes); Breast Imaging Centre, Centre hospitalier de l'Université de Montréal (Lalonde, Trop); Hôpital du Sacré-Coeur de Montréal and Groupe d'Étude en Oncologie du Québec (L'Espérance); Royal Victoria Hospital and Cedars Breast Clinic of the McGill University Health Centre (Meterissian); Centre Intégré en traitement, recherche et enseignement en Cancer du Sein, Centre hospitalier de l'Université de Montréal (Richard); Sir Mortimer B. Davis Jewish General Hospital and McGill University (Wong).
authors.forename: J
authors.initials: J
authors.lastname: Gagnon
authors.affiliation: Montreal, QC: Centre of Genomics and Policy, Department of Human Genetics, McGill University (Gagnon, Lévesque, Knoppers); Quebec Breast Cancer Foundation [Dumais (observing member)]; Sir Mortimer B. Davis Jewish General Hospital and McGill University Health Centre (Foulkes); Breast Imaging Centre, Centre hospitalier de l'Université de Montréal (Lalonde, Trop); Hôpital du Sacré-Coeur de Montréal and Groupe d'Étude en Oncologie du Québec (L'Espérance); Royal Victoria Hospital and Cedars Breast Clinic of the McGill University Health Centre (Meterissian); Centre Intégré en traitement, recherche et enseignement en Cancer du Sein, Centre hospitalier de l'Université de Montréal (Richard); Sir Mortimer B. Davis Jewish General Hospital and McGill University (Wong).
authors.forename: E
authors.initials: E
authors.lastname: Lévesque
authors.affiliation: Quebec City, QC: Public Health Branch, Capitale-Nationale (Borduas); Centre hospitalier universitaire ( chu ) de Québec-Université Laval (Chiquette, Duchesne, Provencher); Centre de coordination des services régionaux, Capitale-Nationale (Chiquette); Quebec Breast Cancer Screening Program (Chiquette, Eloy); chu de Québec-Université Laval Research Center and Department of Social and Preventive Medicine, Université Laval (Diorio); Cancer Branch, Ministry of Health and Social Services (Eloy); Deschênes-Fabia Breast Diseases Center (Provencher); chu de Québec-Université Laval (Duchesne); Canada Research Chair in Oncogenetics, chu de Québec-Université Laval Research Centre, and Department of Molecular Medicine, Université Laval (Simard).
authors.forename: F
authors.initials: F
authors.lastname: Borduas
authors.affiliation: Quebec City, QC: Public Health Branch, Capitale-Nationale (Borduas); Centre hospitalier universitaire ( chu ) de Québec-Université Laval (Chiquette, Duchesne, Provencher); Centre de coordination des services régionaux, Capitale-Nationale (Chiquette); Quebec Breast Cancer Screening Program (Chiquette, Eloy); chu de Québec-Université Laval Research Center and Department of Social and Preventive Medicine, Université Laval (Diorio); Cancer Branch, Ministry of Health and Social Services (Eloy); Deschênes-Fabia Breast Diseases Center (Provencher); chu de Québec-Université Laval (Duchesne); Canada Research Chair in Oncogenetics, chu de Québec-Université Laval Research Centre, and Department of Molecular Medicine, Université Laval (Simard).
authors.forename: J
authors.initials: J
authors.lastname: Chiquette
authors.affiliation: Quebec City, QC: Public Health Branch, Capitale-Nationale (Borduas); Centre hospitalier universitaire ( chu ) de Québec-Université Laval (Chiquette, Duchesne, Provencher); Centre de coordination des services régionaux, Capitale-Nationale (Chiquette); Quebec Breast Cancer Screening Program (Chiquette, Eloy); chu de Québec-Université Laval Research Center and Department of Social and Preventive Medicine, Université Laval (Diorio); Cancer Branch, Ministry of Health and Social Services (Eloy); Deschênes-Fabia Breast Diseases Center (Provencher); chu de Québec-Université Laval (Duchesne); Canada Research Chair in Oncogenetics, chu de Québec-Université Laval Research Centre, and Department of Molecular Medicine, Université Laval (Simard).
authors.forename: C
authors.initials: C
authors.lastname: Diorio
authors.affiliation: Quebec City, QC: Public Health Branch, Capitale-Nationale (Borduas); Centre hospitalier universitaire ( chu ) de Québec-Université Laval (Chiquette, Duchesne, Provencher); Centre de coordination des services régionaux, Capitale-Nationale (Chiquette); Quebec Breast Cancer Screening Program (Chiquette, Eloy); chu de Québec-Université Laval Research Center and Department of Social and Preventive Medicine, Université Laval (Diorio); Cancer Branch, Ministry of Health and Social Services (Eloy); Deschênes-Fabia Breast Diseases Center (Provencher); chu de Québec-Université Laval (Duchesne); Canada Research Chair in Oncogenetics, chu de Québec-Université Laval Research Centre, and Department of Molecular Medicine, Université Laval (Simard).
authors.forename: N
authors.initials: N
authors.lastname: Duchesne
authors.affiliation: Montreal, QC: Centre of Genomics and Policy, Department of Human Genetics, McGill University (Gagnon, Lévesque, Knoppers); Quebec Breast Cancer Foundation [Dumais (observing member)]; Sir Mortimer B. Davis Jewish General Hospital and McGill University Health Centre (Foulkes); Breast Imaging Centre, Centre hospitalier de l'Université de Montréal (Lalonde, Trop); Hôpital du Sacré-Coeur de Montréal and Groupe d'Étude en Oncologie du Québec (L'Espérance); Royal Victoria Hospital and Cedars Breast Clinic of the McGill University Health Centre (Meterissian); Centre Intégré en traitement, recherche et enseignement en Cancer du Sein, Centre hospitalier de l'Université de Montréal (Richard); Sir Mortimer B. Davis Jewish General Hospital and McGill University (Wong).
authors.forename: M
authors.initials: M
authors.lastname: Dumais
authors.affiliation: Quebec City, QC: Public Health Branch, Capitale-Nationale (Borduas); Centre hospitalier universitaire (chu) de Québec-Université Laval (Chiquette, Duchesne, Provencher); Centre de coordination des services régionaux, Capitale-Nationale (Chiquette); Quebec Breast Cancer Screening Program (Chiquette, Eloy); chu de Québec-Université Laval Research Center and Department of Social and Preventive Medicine, Université Laval (Diorio); Cancer Branch, Ministry of Health and Social Services (Eloy); Deschênes-Fabia Breast Diseases Center (Provencher); chu de Québec-Université Laval (Duchesne); Canada Research Chair in Oncogenetics, chu de Québec-Université Laval Research Centre, and Department of Molecular Medicine, Université Laval (Simard);; Joliette, QC: Centre hospitalier régional de Lanaudière (Eloy).
authors.forename: L
authors.initials: L
authors.lastname: Eloy
authors.affiliation: Montreal, QC: Centre of Genomics and Policy, Department of Human Genetics, McGill University (Gagnon, Lévesque, Knoppers); Quebec Breast Cancer Foundation [Dumais (observing member)]; Sir Mortimer B. Davis Jewish General Hospital and McGill University Health Centre (Foulkes); Breast Imaging Centre, Centre hospitalier de l'Université de Montréal (Lalonde, Trop); Hôpital du Sacré-Coeur de Montréal and Groupe d'Étude en Oncologie du Québec (L'Espérance); Royal Victoria Hospital and Cedars Breast Clinic of the McGill University Health Centre (Meterissian); Centre Intégré en traitement, recherche et enseignement en Cancer du Sein, Centre hospitalier de l'Université de Montréal (Richard); Sir Mortimer B. Davis Jewish General Hospital and McGill University (Wong).
authors.forename: W
authors.initials: W
authors.lastname: Foulkes
authors.affiliation: Rivière-du-Loup, QC: Centre hospitalier du Grand-Portage (Gervais).
authors.forename: N
authors.initials: N
authors.lastname: Gervais
authors.affiliation: Montreal, QC: Centre of Genomics and Policy, Department of Human Genetics, McGill University (Gagnon, Lévesque, Knoppers); Quebec Breast Cancer Foundation [Dumais (observing member)]; Sir Mortimer B. Davis Jewish General Hospital and McGill University Health Centre (Foulkes); Breast Imaging Centre, Centre hospitalier de l'Université de Montréal (Lalonde, Trop); Hôpital du Sacré-Coeur de Montréal and Groupe d'Étude en Oncologie du Québec (L'Espérance); Royal Victoria Hospital and Cedars Breast Clinic of the McGill University Health Centre (Meterissian); Centre Intégré en traitement, recherche et enseignement en Cancer du Sein, Centre hospitalier de l'Université de Montréal (Richard); Sir Mortimer B. Davis Jewish General Hospital and McGill University (Wong).
authors.forename: L
authors.initials: L
authors.lastname: Lalonde
authors.affiliation: Montreal, QC: Centre of Genomics and Policy, Department of Human Genetics, McGill University (Gagnon, Lévesque, Knoppers); Quebec Breast Cancer Foundation [Dumais (observing member)]; Sir Mortimer B. Davis Jewish General Hospital and McGill University Health Centre (Foulkes); Breast Imaging Centre, Centre hospitalier de l'Université de Montréal (Lalonde, Trop); Hôpital du Sacré-Coeur de Montréal and Groupe d'Étude en Oncologie du Québec (L'Espérance); Royal Victoria Hospital and Cedars Breast Clinic of the McGill University Health Centre (Meterissian); Centre Intégré en traitement, recherche et enseignement en Cancer du Sein, Centre hospitalier de l'Université de Montréal (Richard); Sir Mortimer B. Davis Jewish General Hospital and McGill University (Wong).
authors.forename: B
authors.initials: B
authors.lastname: L'Espérance
authors.affiliation: Montreal, QC: Centre of Genomics and Policy, Department of Human Genetics, McGill University (Gagnon, Lévesque, Knoppers); Quebec Breast Cancer Foundation [Dumais (observing member)]; Sir Mortimer B. Davis Jewish General Hospital and McGill University Health Centre (Foulkes); Breast Imaging Centre, Centre hospitalier de l'Université de Montréal (Lalonde, Trop); Hôpital du Sacré-Coeur de Montréal and Groupe d'Étude en Oncologie du Québec (L'Espérance); Royal Victoria Hospital and Cedars Breast Clinic of the McGill University Health Centre (Meterissian); Centre Intégré en traitement, recherche et enseignement en Cancer du Sein, Centre hospitalier de l'Université de Montréal (Richard); Sir Mortimer B. Davis Jewish General Hospital and McGill University (Wong).
authors.forename: S
authors.initials: S
authors.lastname: Meterissian
authors.affiliation: Quebec City, QC: Public Health Branch, Capitale-Nationale (Borduas); Centre hospitalier universitaire ( chu ) de Québec-Université Laval (Chiquette, Duchesne, Provencher); Centre de coordination des services régionaux, Capitale-Nationale (Chiquette); Quebec Breast Cancer Screening Program (Chiquette, Eloy); chu de Québec-Université Laval Research Center and Department of Social and Preventive Medicine, Université Laval (Diorio); Cancer Branch, Ministry of Health and Social Services (Eloy); Deschênes-Fabia Breast Diseases Center (Provencher); chu de Québec-Université Laval (Duchesne); Canada Research Chair in Oncogenetics, chu de Québec-Université Laval Research Centre, and Department of Molecular Medicine, Université Laval (Simard).
authors.forename: L
authors.initials: L
authors.lastname: Provencher
authors.affiliation: Montreal, QC: Centre of Genomics and Policy, Department of Human Genetics, McGill University (Gagnon, Lévesque, Knoppers); Quebec Breast Cancer Foundation [Dumais (observing member)]; Sir Mortimer B. Davis Jewish General Hospital and McGill University Health Centre (Foulkes); Breast Imaging Centre, Centre hospitalier de l'Université de Montréal (Lalonde, Trop); Hôpital du Sacré-Coeur de Montréal and Groupe d'Étude en Oncologie du Québec (L'Espérance); Royal Victoria Hospital and Cedars Breast Clinic of the McGill University Health Centre (Meterissian); Centre Intégré en traitement, recherche et enseignement en Cancer du Sein, Centre hospitalier de l'Université de Montréal (Richard); Sir Mortimer B. Davis Jewish General Hospital and McGill University (Wong).
authors.forename: J
authors.initials: J
authors.lastname: Richard
authors.affiliation: St-Raymond, QC: Centre de santé et de services sociaux de Portneuf (Savard).
authors.forename: C
authors.initials: C
authors.lastname: Savard
authors.affiliation: Montreal, QC: Centre of Genomics and Policy, Department of Human Genetics, McGill University (Gagnon, Lévesque, Knoppers); Quebec Breast Cancer Foundation [Dumais (observing member)]; Sir Mortimer B. Davis Jewish General Hospital and McGill University Health Centre (Foulkes); Breast Imaging Centre, Centre hospitalier de l'Université de Montréal (Lalonde, Trop); Hôpital du Sacré-Coeur de Montréal and Groupe d'Étude en Oncologie du Québec (L'Espérance); Royal Victoria Hospital and Cedars Breast Clinic of the McGill University Health Centre (Meterissian); Centre Intégré en traitement, recherche et enseignement en Cancer du Sein, Centre hospitalier de l'Université de Montréal (Richard); Sir Mortimer B. Davis Jewish General Hospital and McGill University (Wong).
authors.forename: I
authors.initials: I
authors.lastname: Trop
authors.affiliation: Montreal, QC: Centre of Genomics and Policy, Department of Human Genetics, McGill University (Gagnon, Lévesque, Knoppers); Quebec Breast Cancer Foundation [Dumais (observing member)]; Sir Mortimer B. Davis Jewish General Hospital and McGill University Health Centre (Foulkes); Breast Imaging Centre, Centre hospitalier de l'Université de Montréal (Lalonde, Trop); Hôpital du Sacré-Coeur de Montréal and Groupe d'Étude en Oncologie du Québec (L'Espérance); Royal Victoria Hospital and Cedars Breast Clinic of the McGill University Health Centre (Meterissian); Centre Intégré en traitement, recherche et enseignement en Cancer du Sein, Centre hospitalier de l'Université de Montréal (Richard); Sir Mortimer B. Davis Jewish General Hospital and McGill University (Wong).
authors.forename: N
authors.initials: N
authors.lastname: Wong
authors.affiliation: Montreal, QC: Centre of Genomics and Policy, Department of Human Genetics, McGill University (Gagnon, Lévesque, Knoppers); Quebec Breast Cancer Foundation [Dumais (observing member)]; Sir Mortimer B. Davis Jewish General Hospital and McGill University Health Centre (Foulkes); Breast Imaging Centre, Centre hospitalier de l'Université de Montréal (Lalonde, Trop); Hôpital du Sacré-Coeur de Montréal and Groupe d'Étude en Oncologie du Québec (L'Espérance); Royal Victoria Hospital and Cedars Breast Clinic of the McGill University Health Centre (Meterissian); Centre Intégré en traitement, recherche et enseignement en Cancer du Sein, Centre hospitalier de l'Université de Montréal (Richard); Sir Mortimer B. Davis Jewish General Hospital and McGill University (Wong).
authors.forename: B M
authors.initials: BM
authors.lastname: Knoppers
authors.affiliation: Quebec City, QC: Public Health Branch, Capitale-Nationale (Borduas); Centre hospitalier universitaire ( chu ) de Québec-Université Laval (Chiquette, Duchesne, Provencher); Centre de coordination des services régionaux, Capitale-Nationale (Chiquette); Quebec Breast Cancer Screening Program (Chiquette, Eloy); chu de Québec-Université Laval Research Center and Department of Social and Preventive Medicine, Université Laval (Diorio); Cancer Branch, Ministry of Health and Social Services (Eloy); Deschênes-Fabia Breast Diseases Center (Provencher); chu de Québec-Université Laval (Duchesne); Canada Research Chair in Oncogenetics, chu de Québec-Université Laval Research Centre, and Department of Molecular Medicine, Université Laval (Simard).
authors.forename: J
authors.initials: J
authors.lastname: Simard
keywords: Breast cancer; clinical practice; prevention; recommendations; screening