Fewer women (60 per cent) would be happy to be screened less often if they were found to be at lower risk.**
More than 940 women from across the UK were asked for their views on the possibility of tailoring breast screening to people’s genetic risk in a study funded by Cancer Research UK and The Eve Appeal. Two-thirds (66 per cent) supported the idea of adjusting the frequency of screening on the basis of risk.
The NHS breast screening programme offers routine mammograms based on age, rather than genetic risk. All women between 50 and 70 are invited for screening every three years, and women over 70 can request screening if they wish, because older women are at increased risk of the disease. Women with a strong family history of breast cancer may be offered a different pattern of screening.
Breast screening can help detect cancers early, when treatment is more likely to be effective, and is estimated to save around 1,300 lives from breast cancer in the UK each year.
But as well as picking up cancers that need treating, screening can also detect very slow-growing cancers that would not have been picked up without screening. This means some women are treated unnecessarily for a cancer that would not have caused any problem during their lifetimes.
Dr Susanne Meisel, research psychologist at UCL (University College London), said: “Looking at whether genetic risk could be used to tailor and improve the breast screening programme is still at an early stage, but it’s useful to find out now what the public might think about this idea. Our study showed that, overall, women seem to support it.
“It’s interesting there was less support for the idea of less frequent screening for people at lower risk of cancer. This could be because many women tend to see screening as beneficial or feel they have a right to screening, or some women might take a ‘better safe than sorry’ approach to cancer screening which may make them more accepting of potential harm from it.”
Women who took part in the study were asked five questions to assess what they believed their risk of developing breast cancer was, and their attitude to genetic testing and using genetic risk to vary screening frequency. Limited information was provided on how a modified screening programme might work, and no information was given on the current screening programme.
Athena Lamnisos, CEO of The Eve Appeal, said: “Women at increased risk of cancer deserve more than the one-size fits all approach. This study shows that women were positive about the idea of adjusting the frequency of mammography screening in line with personal genetic risk. It also shows how critical it is to develop effective communication materials – both for women at high risk and those at lower genetic risk.”
Jessica Kirby, senior health information manager at Cancer Research UK, said: “Breast screening saves lives, but it also has risks. One suggestion to try to maximise the benefit and reduce the risk is to tailor screening more effectively to people’s risk of breast cancer, but more research is needed to show whether this approach will be effective or possible.
“This interesting study suggests that women are generally positive about the idea of tailoring screening, but in the meantime, it’s critical that women are offered proper information about the benefits and risks of screening, and supported to make an informed decision.”
*Susanne F Meisel et al – ‘Adjusting the frequency of mammography screening on the basis of genetic risk: Attitudes among women in the UK’.
The data are drawn from the health behaviour aspect of PROMISE 2016. Researchers are based at the Health Behaviour Research Centre, UCL; Department of Applied Health Research, UCL; and the Department of Women’s Cancer, UCL Elizabeth Garrett Anderson Institute for Women’s Health, UCL.
** 942 women were asked the following five questions and answered by choosing one of a number of set responses:
It is possible that breast screening frequency could be varied depending on whether a woman is at higher or lower genetic risk of breast cancer. What do you think of the idea of varying the frequency of breast screening?
Would you personally be happy to have your breast screening more often if you were found to be at higher genetic risk of breast cancer?
Would you personally be happy to have your breast screening less often if you were found to be at lower genetic risk of breast cancer?
Based on what you know, do you think genetic testing will do more good than harm, or more harm than good?
Compared with other women of your age, what do you think are your chances of getting breast cancer?
65.8 per cent of the women supported the idea of varying screening frequency on the basis of genetic risk;
85.4 per cent were willing to have more frequent breast screening if they were found to be at higher
risk; 58.8 per cent were willing to have less frequent screening if at lower risk.
The work was undertaken within “PROMISE 2016″ a 5 year research programme led by Principal Investigator Prof Ian Jacobs focused on developing novel risk prediction models for use in ovarian cancer screening. PROMISE takes a personalised screening approach by predicting a woman’s risk of ovarian cancer using clinical, epidemiological, proteomic and genetic data, and stratifying the subsequent information, support and risk management options depending on the woman’s level of risk. Genetic data will include testing the high penetrance genes associated with hereditary breast and ovarian cancer, BRCA1 and BRCA2, as well lower penetrance genes associated with ovarian cancer susceptibility. The work has the potential to streamline cancer screening and reduce overdiagnosis and overtreatment.