Title page
Contents
About Public Health England 2
Contributors 6
Executive summary 7
1. Introduction 10
1.1. Remit 10
1.2. Background 10
1.3. Scope and limitations 11
1.4. Approach 12
2. Findings 13
2.1. Estimating the net effect on breast cancer mortality of possible screening interventions aimed at women with greater than average risk 13
2.1.1. Programmes considered 13
2.1.2. Methods 14
2.1.3. Results 15
2.1.3.1. Screening programmes aimed at women at moderately high risk of breast cancer (RR of 2 to 4) 15
2.1.3.2. Screening programmes aimed at women at very high risk of breast cancer (RR of 8) 17
2.2. High hereditary risk 19
2.2.1. Definition 19
2.2.2. Prevalence 20
2.2.3. Penetrance of breast cancer 20
2.2.4. TP53 21
2.2.5. Multiple primary breast cancer 22
2.2.6. Summary 22
2.3. Epidemiological risk factors 22
2.4. Benign breast disease and premalignant conditions 25
2.5. Supradiaphragmatic irradiation at age below 30 25
2.6. HTA document on surveillance after breast cancer treatment 25
3. Conclusions 27
3.1. Screening programmes 27
3.2. Identification of risk groups 28
3.2.1. Women with high hereditary risk (RR 3 to 8 or ≥8) 28
3.2.2. Women with high risk, as defined by epidemiological risk factors (RR 3 to 8) 28
3.2.3. Women with atypical ductal or lobular hyperplasia and women with lobular carcinoma in situ (RR 3 to 8) 28
3.2.4. Women at high risk after receiving SDI before age of 30 (RR ≥8) 29
3.2.5. Women with a previously treated breast cancer who have a 1% or greater annual risk of ipsilateral or contralateral new breast events (RR 3 to 8) 29
3.3. Alignment of screening recommendations 29
3.4. Level of risk required when new risk factors are considered 29
3.5. Population effect 29
3.6. New developments, eg using MRI as screening tool 30
3.7. Evaluation of programmes 30
References 31
Table 1. Estimated effect on breast cancer mortality of various screening programmes per unit RR of breast cancer in the target population 15
Table 2. Estimated risks and benefits associated with annual MRI/mammographic screening of women with a very strong hereditary risk of breast cancer (RR=8) 18
Table 3. Cumulative risk of breast cancer by 70 years for BRCA1 and BRCA2 20
Table 4. Penetrance for breast cancer by age 21
Table 5. Stratification of the population into risk categories based on parity, hormone use, breast density, alcohol consumption, obesity, and benign breast disease. 24
Figure 1. Estimated number of women who would need to be screened, under alternative extended screening programmes, to avoid one extra breast cancer death relative to the standard programme. 16
Figure 2. Estimated number of additional screens needed, under alternative extended screening programmes, in order to avoid one extra breast cancer death relative to the standard programme. 17