16 August 2021

Personalising breast cancer screening

Breast cancer Clinical

Knowledge about breast cancer risk factors and medical imaging technology has advanced enormously over the past 20 years. 

However, our system for breast cancer screening has remained largely unchanged since the mid-1990s, with most women over 50 being offered biennial mammographic screening unless they are in high risk. 

Cancer Council Australia is undertaking a large, Australian Government funded project to investigate how to potentially personalise screening, to help optimise the early detection of breast cancer in Australia. 

The breast cancer Roadmap for Optimising Screening in Australia (ROSA) project, established in 2018, is generating and assembling national and international evidence to help identify the best way forward.

Leading the project is Associate Professor Carolyn Nickson from the Daffodil Centre, (a joint venture between NSW Cancer Council and the University of Sydney) and the University of Melbourne.

Leading surgical oncologists are also supporting the project – Professor Bruce Mann, University of Melbourne and Director of Breast Services at Royal Women’s and Royal Melbourne Hospitals is co-chair of the Expert Advisory Group (EAG) and Professor Christobel Saunders AO from the University of Western Australia is an EAG member.

They both believe there is potential for a nationally consistent approach to BreastScreen offering tailored screening for women with different levels of risk.  

“While BreastScreen has contributed enormously to improved outcomes for those diagnosed with breast cancer, there is more we can do,” says Professor Mann.

“We need to reduce the number of women diagnosed with later stage cancer, so that treatment can be more effective. ROSA offers our best opportunity to do this.”

Professor Saunders who is a consultant surgeon for Fiona Stanley Hospital and St John of God Hospital Subiaco, believes modelling data generated by the project can contribute to refining approaches to personalised risk-based screening. “Clearly BreastScreen offers a fantastic service and outcomes to Australian women and has done over many years, but if we can use the information and data generated by screening programs to actually improve BreastScreen outcomes, and tailor services more to the individual and her personal risk, this would be a great achievement.”

There are several different elements to the project as Associate Professor Nickson explains. “We are analysing existing breast cancer risk tools, including our understanding of the role of breast density in both risk and screening accuracy, and the exploring the latest evidence on new technologies in breast imaging. The goal is to recommend options that would safely and economically improve breast screening services for Australian women,” 

In 2021-22, the ROSA research team’s activities include comparing the expected benefits, harms and costs of different risk-based screening approaches and mapping out how screening and clinical health services could work together as smoothly as possible if more risk-based screening protocols are trialled in Australian health care settings.  

This project is guided by a five-year roadmap that includes horizon-scanning for emerging technologies and innovations.

To be kept up to date with the ROSA project, contact Amanda Tattam  rosa@nswcc.org.au

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