Abstract
In France, more than 10 million women at ”average” risk of breast cancer (BC), are included in the organized BC screening. Existing predictive models of BC risk are not adapted to the French population. Thus, we set up a new score in the French Hérault region and looked for subgroups at a graded level of risk in women at ”average” risk. We recruited a retrospective cohort of women, aged 50 to 60, who underwent the organized BC screening, and included 2241 non-cancer women and 527 who developed a BC during a 12-year follow-up period (2006-2018). The risk factors identified were high breast density (ACR BI-RADS grading)(B vs A: HR = 1.41, 95%CI [1.05; 1.9], p = 0.023; C vs A: HR = 1.65 [1.2; 2.27], p = 0.02 ; D vs A: HR = 2.11 [1.25;3.58], p = 0.006), a history of maternal breast cancer (HR = 1.61 [1.24; 2.09], p < 0.001), and socioeconomic difficulties (HR 1.23 [1.09; 1.55], p = 0.003). While early menopause (HR = 0.36 [0.13; 0.99], p = 0.003) and an age at menarche after 12 years (HR = 0.77 [0.63; 0.95], p = 0.047) were protective factors. We identified 3 groups at risk: lower, average, and higher, respectively. A low threshold was characterized at 1.9% of 12-year risk and a high threshold at 4.5% 12-year risk. Mean 12-year risks in the 3 groups of risk were 1.37%, 2.68%, and 5.84%, respectively. Thus, 12% of women presented a level of risk different from the average risk group, corresponding to 600,000 women involved in the French organized BC screening, enabling to propose a new strategy to personalize the national BC screening. On one hand, for women at lower risk, we proposed to reduce the frequency of mammograms and on the other hand, for women at higher risk, we suggested intensifying surveillance.
Highlights
Breast cancer is the most common cancer in women and the leading cause of death from cancer in women in France[1]
Several predictive models already exist, such as Gail8, BRCAPRO9, BODICEA10, Tyrer-Cuzick[11], or P ROCAS12 models. They are not adapted to some European p opulations[13] and most of them include BRCA1 and BRCA2 mutations
In France, women presenting with these mutations are not included in the organized nationwide screening and, as explained in PROCAS12, mutations in breast cancer genes such as BRCA1 and BRCA2 are too infrequent to affect risk prediction appreciably in the models for the general population
Summary
Breast cancer is the most common cancer in women and the leading cause of death from cancer in women in France[1]. In April 2017, the Ministry of Health published an action plan to renovate the organized breast cancer screening[6] based on the recommendations of the National Cancer Institute and at the request of the women interviewed during the citizen consultation to determine the levels of risk for the population at ”average” r isk[7] This reorganization plan aimed to enable a more personalized organized screening, and encouraged research projects on tools and methods for assessing the level of risk, including scoring. The aim of our study was to explore whether, among the 10 million women at ”average-risk” targeted by the French organized screening, some women would be at lower-risk than average risk and others at higher risk The aim of this personalized organized screening is to optimize the available resources to make screening as efficient as possible. We intended to set up a new risk model, including new variables, adapted to the French population, and enabling to explore whether in this average risk population it was possible to identify women at lower risk of breast cancer (or higher risk, respectively) in order to adapt the organized screening by proposing a different organized screening strategy depending on the level of risk identified
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