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Walker MJ, Blackmore KM, Chang A, Lambert-Côté L, Turgeon A, Antoniou AC, Bell KA, Broeders MJM, Brooks JD, Carver T, Chiquette J, Després P, Easton DF, Eisen A, Eloy L, Evans DG, Fienberg S, Joly Y, Kim RH, Kim SJ, Knoppers BM, Lofters AK, Nabi H, Paquette JS, Pashayan N, Sheppard AJ, Stockley TL, Dorval M, Simard J, Chiarelli AM. Implementing Multifactorial Risk Assessment with Polygenic Risk Scores for Personalized Breast Cancer Screening in the Population Setting: Challenges and Opportunities. Cancers (Basel) 2024; 16:2116. [PMID: 38893236 PMCID: PMC11171515 DOI: 10.3390/cancers16112116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/11/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Risk-stratified breast screening has been proposed as a strategy to overcome the limitations of age-based screening. A prospective cohort study was undertaken within the PERSPECTIVE I&I project, which will generate the first Canadian evidence on multifactorial breast cancer risk assessment in the population setting to inform the implementation of risk-stratified screening. Recruited females aged 40-69 unaffected by breast cancer, with a previous mammogram, underwent multifactorial breast cancer risk assessment. The adoption of multifactorial risk assessment, the effectiveness of methods for collecting risk factor information and the costs of risk assessment were examined. Associations between participant characteristics and study sites, as well as data collection methods, were assessed using logistic regression; all p-values are two-sided. Of the 4246 participants recruited, 88.4% completed a risk assessment, with 79.8%, 15.7% and 4.4% estimated at average, higher than average and high risk, respectively. The total per-participant cost for risk assessment was CAD 315. Participants who chose to provide risk factor information on paper/telephone (27.2%) vs. online were more likely to be older (p = 0.021), not born in Canada (p = 0.043), visible minorities (p = 0.01) and have a lower attained education (p < 0.0001) and perceived fair/poor health (p < 0.001). The 34.4% of participants requiring risk factor verification for missing/unusual values were more likely to be visible minorities (p = 0.009) and have a lower attained education (p ≤ 0.006). This study demonstrates the feasibility of risk assessment for risk-stratified screening at the population level. Implementation should incorporate an equity lens to ensure cancer-screening disparities are not widened.
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Affiliation(s)
- Meghan J. Walker
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
| | | | - Amy Chang
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada
| | | | - Annie Turgeon
- CHU de Québec-Université Laval Research Center, Queébec City, QC G1V 4G2, Canada
| | - Antonis C. Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge CB1 8RN, UK
| | - Kathleen A. Bell
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada
| | - Mireille J. M. Broeders
- Department for Health Evidence, Radboud University Medical Center, 6525EP Nijmegen, The Netherlands
| | - Jennifer D. Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Tim Carver
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge CB1 8RN, UK
| | - Jocelyne Chiquette
- CHU de Québec-Université Laval Research Center, Queébec City, QC G1V 4G2, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, QC G1V 0A6, Canada;
| | - Philippe Després
- Department of Physics, Engineering Physics and Optics, Faculty of Science and Engineering, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Douglas F. Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge CB1 8RN, UK
| | - Andrea Eisen
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada
- Sunnybrook Health Science Center, Toronto, ON M4N 3M5, Canada
| | - Laurence Eloy
- Québec Cancer Program, Ministère de la Santé et des Services Sociaux, Quebec City, QC G1S 2M1, Canada
| | - D. Gareth Evans
- Division of Evolution Infection and Genomic Sciences, The University of Manchester, Manchester M13 9PL, UK
| | | | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada
| | - Raymond H. Kim
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada
- Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Shana J. Kim
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Bartha M. Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada
| | - Aisha K. Lofters
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
- Women’s College Research Institute, Toronto, ON M5G 1N8, Canada
| | - Hermann Nabi
- CHU de Québec-Université Laval Research Center, Queébec City, QC G1V 4G2, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Université Laval Cancer Research Center, Quebec City, QC G1R 3S3, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, QC G1V 0A6, Canada;
| | - Nora Pashayan
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge CB1 8RN, UK
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, London WC1E 6BT, UK
| | - Amanda J. Sheppard
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Tracy L. Stockley
- Division of Clinical Laboratory Genetics, University Health Network, Toronto, ON M5G 2C4, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Michel Dorval
- CHU de Québec-Université Laval Research Center, Queébec City, QC G1V 4G2, Canada
- Université Laval Cancer Research Center, Quebec City, QC G1R 3S3, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Jacques Simard
- CHU de Québec-Université Laval Research Center, Queébec City, QC G1V 4G2, Canada
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 4G2, Canada
| | - Anna M. Chiarelli
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
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Klassen CL, Viers LD, Ghosh K. Following the High-Risk Patient: Breast Cancer Risk-Based Screening. Ann Surg Oncol 2024; 31:3154-3159. [PMID: 38302622 DOI: 10.1245/s10434-024-14957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
Breast cancer (BC) is the most common cancer occurring in women in the USA today, and accounts for more than 40,000 deaths annually (Giaquinto in CA Cancer J Clin 72: 524-541, 2022). While breast cancer survival has improved over the past decades, incidence has increased, and diagnoses are being made at younger ages. This emphasizes the importance of risk evaluation, accurate prediction, and effective mitigation and risk reduction strategies. Enhanced screening can help detect cancers at an earlier stage, thus improving morbidity and mortality. This review addresses the recognition of women at high-risk for BC and monitoring strategies for those at high risk.
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Affiliation(s)
- Christine L Klassen
- Mayo School of Graduate Medical Education, Mayo Clinic- Rochester, Rochester, MN, USA.
| | - Lyndsay D Viers
- Mayo School of Graduate Medical Education, Mayo Clinic- Rochester, Rochester, MN, USA
| | - Karthik Ghosh
- Mayo School of Graduate Medical Education, Mayo Clinic- Rochester, Rochester, MN, USA
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