Screening FEWER women for breast cancer could reduce deaths from the disease and save the NHS money, study claims
- All women are currently offered screening every three years after they reach 50
- But scientists say screening based on individual risk could be more effective
- Risk-based cancer screening could reduce deaths by 10 per cent, experts say
Screening women for breast cancer based on risk instead of age could save the NHS money and cut deaths by up to 10 per cent, according to research.
Reducing the number of women who are screened would save lives and resources by diagnosing fewer women who won’t actually develop the cancer.
The NHS currently offers a digital mammogram – a breast scan – every three years for women aged 50 to 69.
But researchers say offering scans based on how likely a woman is to get cancer, instead of their age, could be a more effective way to do it.
The risk of getting the cancer varies among women and can be predicted more accurately by considering their genes and lifestyle factors.
Screening fewer women would also lead to fewer women being ‘overdiagnosed’ and having unnecessary treatment or stress.
Screening women based on risk could reduce the number of overdiagnoses, in which women are given treatment or a diagnosis when they are not showing symptoms of the disease.
A targeted ‘risk-based’ breast screening programme could do ‘more good than harm’ according to a study led by University College London.
Currently women accept 72 per cent of offers of free breast cancer screening, but these may not be the women most in danger of getting the disease.
The researchers say avoiding screening women who aren’t likely to get the disease could be more affordable for the NHS and save more lives.
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Only offering screening to the 30 per cent of most at-risk women could result in 10 per cent fewer breast cancer deaths and save the NHS more than half a million pounds, according to the research.
Meanwhile, keeping screening at 70 per cent would still produce an improvement, causing 3 per cent fewer deaths and saving the NHS £20,000.
Targeted screening could reduce unnecessary diagnoses
Both would also reduce the number of overdiagnoses, in which women are given treatment or a diagnosis when they are not showing signs of the disease.
This may be because a mammogram shows early warning signs of a tumour but the cancer has not developed, and possibly never would.
Overdiagnosis would be cut by 71 per cent if screening is limited to 30 per cent of women, and 27 per cent if limited to 70 per cent of women.
WHAT ARE THE SYMPTOMS OF BREAST CANCER?
Around 55,200 people are diagnosed with breast cancer in the UK each year.
One in eight women develop the disease during their lifetime.
The illness can cause a number of symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.
Most breast lumps aren’t cancerous, but it’s always best to have them checked by your doctor.
According to NHS Choices you should also see your GP if you notice any of the following:
- A change in the size or shape of one or both breasts
- Discharge from either of your nipples, which may be streaked with blood
- A lump or swelling in either of your armpits
- Dimpling on the skin of your breasts
- A rash on or around your nipple
- A change in the appearance of your nipple, such as becoming sunken into your breast
Breast pain isn’t usually a symptom of breast cancer.
Study author Dr Nora Pashayan from UCL said: ‘Breast screening has both benefits and harms: it can reduce death from breast cancer in some women while others may have unnecessary diagnosis and treatment of breast cancer.
‘Offering screening according to women’s risk level could improve the efficiency of the screening programme and reduce its harms.’
Researchers worked out the efficiency of a risk-based system by simulating the 2009 population of women over 50 – 364,500 people – in three screening scenarios.
Cost-efficiency and survival rates are improved
In one scenario the women received no screening, in another they received the current NHS screening programme and in a third they received screening based on their individual risk of getting breast cancer.
Cost effectiveness was worked out using NHS costs for the screening programme and costs of breast cancer treatment.
The team found survival rates and cost-efficiency to the health system were better in both, and the level of overdiagnosis was lower – so the quality of life for the women who did not actually get cancer was better.
Even the less extreme model, in which 70 per cent of women are still screened, but they are targeted based on their disease risk, would be more effective, the study claims.
But there would be an extra challenge in finding the right women to screen.
Dr Pashayan added: ‘The take-up of breast screening is currently around 72 per cent.
‘If we maintain this take-up but in a way that women who would benefit more from screening attend and women who would be more harmed from screening are spared, then the cost-effectiveness and benefit-to-harm balance of the NHS breast screening programme could be improved.
‘There are now more than 300 known variants within the human genome, which increase a women’s risk to breast cancer.
Experts realise finding the right women to screen could be challenging
‘With genotype analysis feasible from cheek swabs, it may be possible for more targeted screening which will both reduce the detriment caused by over diagnosis and increase the chances of early diagnosis for those at risk.
‘However we recognise implementing an initiative of this nature raises challenges – not least defining those women deemed low risk and making any screening based on risk acceptable to the public, health professionals and regulators.’
Professor Fiona Gilbert, a co-author of the study from the University of Cambridge, added: ‘We need to change the model of delivery of breast screening and recognise that women are individuals with different risks and lifestyles.
‘They should be offered screening tailored to their own profile.’
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