The current status of risk-stratified breast screening.
The current status of risk-stratified breast screening.
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DOI：
10.1038/s41416-021-01550-3
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发表时间：
2022-03
影响因子：
8.8
通讯作者：
Hippisley-Cox J
中科院分区：
文献类型：
--
作者：
Clift AK;Dodwell D;Lord S;Petrou S;Brady SM;Collins GS;Hippisley-Cox J
除了高风险的情况下，如存在高度渗透性的基因突变，乳房筛查通常包括乳房X光检查或断层合成策略，由年龄定义。然而，基于年龄的筛查忽视了个体女性可能拥有的乳腺癌风险范围，并且与个性化早期检测的雄心背道而驰。虽然筛查性乳房X光检查降低了乳腺癌死亡率，但这存在潜在的重大危害风险，包括过度诊断和过度治疗，以及与假阳性相关的心理发病率。在风险分层筛选中，个体化风险评估可能会告知筛选强度/间隔、起始年龄、使用的成像方式，甚至决定不进行筛选。然而，需要建立其益处和危害的明确证据。在这篇范围审查中，作者总结了关于成功的风险分层乳腺筛查的几个关键依赖性的已建立和新出现的证据：风险预测模型性能，流行病学研究，回顾性临床评价，卫生经济学评价以及可行性和可接受性的定性研究。家族史、乳腺密度或生殖因素本身并不适合精确估计风险，风险预测模型越来越多地结合人口统计学、临床、遗传和成像相关参数。风险分层筛选的临床评价目前是有限的。流行病学证据很少，随机试验也是近几年才开始的。
Apart from high-risk scenarios such as the presence of highly penetrant genetic mutations, breast screening typically comprises mammography or tomosynthesis strategies defined by age. However, age-based screening ignores the range of breast cancer risks that individual women may possess and is antithetical to the ambitions of personalised early detection. Whilst screening mammography reduces breast cancer mortality, this is at the risk of potentially significant harms including overdiagnosis with overtreatment, and psychological morbidity associated with false positives. In risk-stratified screening, individualised risk assessment may inform screening intensity/interval, starting age, imaging modality used, or even decisions not to screen. However, clear evidence for its benefits and harms needs to be established. In this scoping review, the authors summarise the established and emerging evidence regarding several critical dependencies for successful risk-stratified breast screening: risk prediction model performance, epidemiological studies, retrospective clinical evaluations, health economic evaluations and qualitative research on feasibility and acceptability. Family history, breast density or reproductive factors are not on their own suitable for precisely estimating risk and risk prediction models increasingly incorporate combinations of demographic, clinical, genetic and imaging-related parameters. Clinical evaluations of risk-stratified screening are currently limited. Epidemiological evidence is sparse, and randomised trials only began in recent years.
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