How to Get Your Patients on Their Best Screening Pathway
Three Key Steps to Personalize Breast Care for Early Cancer Detection
Step 1. Encourage Women to Be Proactive About Cancer Screening
The need for greater participation in breast cancer screening programs cannot be overlooked. An estimated 1 in 8 women will develop breast cancer in her lifetime. However, according to the Centers for Disease Control and Prevention (CDC), only 65% of US women over 40 years old have their recommended mammogram. A large portion of the population is at risk of having their cancer detected at a later stage, reducing their chance of survival, as indicated by recent data from the Office for National Statistics and Public Health England (see Figure 1).
Fortunately, for women receiving mammograms, advances in cancer screening offer personalized pathways for detecting cancers earlier. So, when is a screening mammogram NOT enough?
Step 2. Use Breast Density to Personalize Screening
While mammography is still the gold standard for reducing deaths from breast cancer, it is not a perfect tool. This is because both dense breast tissue and breast cancer appear white on a mammogram (see Figure 2). Dense breast tissue can mask, or camouflage, the presence of cancer. Importantly, approximately 40% women of mammography screening age have heterogeneously or extremely dense breast tissue that impairs the visibility of cancer on a mammogram. A personalized breast care plan for these women may include a recommendation for additional screening methods such as ultrasound to improve the detection of a breast cancer that might be missed on a mammogram.
In addition to a “masking” risk for visualizing cancer on a mammogram, breast density is also an independent risk factor for the development of breast cancer. Studies have shown that women who have extremely dense breast tissue are at a greater risk of developing breast cancer than those who have average breast density. Furthermore, dense breast tissue is linked to the development of more aggressive cancers. Aggressive cancers are known to develop at an earlier age, grow at a more rapid rate, and have reduced response to therapy. So, how do you know if your patient is at a higher risk of developing breast cancer?
Step 3. Understand the Patient’s Risk for Developing Breast Cancer
A breast cancer risk assessment is a tool to help identify women who may benefit from additional breast screening or genetic testing. The Tyrer-Cuzick breast cancer risk assessment is commonly used in breast screening clinics because it has been shown to be superior to other risk models at identifying women who are at high risk. It encompasses the most comprehensive set of variables, including personal and family risk factors that extend to first-degree relatives (parents, siblings, and children) and second-degree relatives (such as aunts and cousins) on both sides of the family.
Even though health organizations differ when it comes to breast cancer screening guideline recommendations, most endorse the Tyrer-Cuzick risk model, including the American Cancer Society (ACS), the National Institute for Health and Care Excellence (NICE), US Preventative Services Task Force (USPSTF), and the American College of Radiology (ACR). See Figure 3 for ACR-recommended guidelines.
Recently, the Tyrer-Cuzick (version 8) breast cancer risk-assessment model added and validated breast density as a risk factor in the model. The validation study used Volpara’s automated Volumetric Breast Density % and ACR’s visual BI-RADS 4th Edition assessment. The results showed that the addition of breast density to this model added value by improving the ability to identify women at both high- and low-risk groups.
Early detection of breast cancer is critical for those at highest risk. The use of a comprehensive risk-assessment model that includes breast density is important for identifying women who should have supplemental screening such as MRI. For these women, supplemental screening currently provides the best way to detect a cancer that is missed on a mammogram.
|Triage Criteria – Screening Mammogram|
< 15% Lifetime Risk
15–20% Lifetime Risk
> 20% Lifetime Risk
Ultrasound – Dense Breasts
|* Ultrasound – Dense Breasts||* MRI – Dense Breasts + personal history||* Ultrasound – Dense Breasts|
* Recommended with conditions
Figure 3. The ACR-recommended guidelines for screening women who are at average, intermediate, and high risk. The ACR endorses the use of Tyrer-Cuzick breast cancer risk assessment for triaging women based on their percentage lifetime risk score.
Does your mammography center tell your patients about breast density? Does your mammography center use the Tyrer-Cuzick risk model to assess breast cancer risk?
Follow this series to learn more about best practices in implementing the Tyrer-Cuzick risk model.
Visit Volpara Solutions during RSNA at booth #4770 in the South Hall, McCormick Convention Center to learn more about our cancer screening platform.