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Personalized breast cancer screening can prevent unnecessary mammography
Every year, around 70,000 women in Germany contract breast cancer. Breast cancer is the most common tumor in women in Germany. In general, the healing chances increase the sooner the tumor is discovered. To improve prevention, it would make sense to invite women for their individual disease risk for early detection.
Better chances of healing with early diagnosis
Breast cancer, also called breast cancer, is the most common malignant tumor in women. In Germany alone, around 70,000 new cases are counted each year. Normally, the sooner the tumor is discovered and the more accurately it can be diagnosed, the chances of recovery increase. Mammography screening serves to detect cancer early. According to some experts, there are only three percent misdiagnosis. The German Cancer Research Center (DKFZ) now points out that many unnecessary examinations could be avoided.
According to experts, many unnecessary mammograms, and thus many false positives, could be avoided if women with a low risk of breast cancer were to be invited to mammography at longer intervals, whereas high-risk women could make extensive use of the investigation. (Image: Sven Bähren / fotolia.com) Avoid unnecessary mammograms
Although women between the ages of 50 and 69 can take part in the breast cancer prevention program free of charge, in some places only about every second goes to mammography screening. Some women are afraid of the examination - it is not completely painless.
Although it is known that the investigation provides no guarantee, according to experts could be discovered within a year but over 17,000 carcinomas by mammography screenings.
But many unnecessary mammograms and thus many false positive findings could be avoided if women with a low risk of breast cancer were invited to mammography at longer intervals, whereas women with high risk could use the investigation closely, the DKFZ writes in a recent communication.
But how can the individual breast cancer risk of a woman be determined as accurately as possible? Scientists at DKFZ want to improve the calculation models used for risk assessment. This is helped by blood samples collected in the EPIC study.
Tumor discovered in curable stage
Experts currently estimate that out of every 1,000 women who regularly go to Mammography for ten years, about one or two will be saved from death by breast cancer because their tumor has been discovered in an even curable stage.
Mammography critics face potential drawbacks in this potential benefit: radiation exposure, unnecessary distress in false positives, and overdiagnoses; the discovery of slow-growing tumors that would not cause any problems during their lifetime.
"The situation could be improved by a personalized early detection, which is adapted to the individual breast cancer risk," says Rudolf Kaaks of the DKFZ.
He explains: "On the one hand, there is the benefit of mammography, namely a lowered breast cancer mortality. On the other hand, there are the risks such as overdiagnosis, false positives and, ultimately, the costs. Our goal is to shift that balance towards benefits. "
Greatest benefit for women at high risk of breast cancer
Of course, women at high risk of developing breast cancer, which means they are more likely to be affected by a tumor, have the greatest benefit from the study.
"These women may be offered close-meshed mammograms, and they may want to start screening at the age of 45. For women with lower risk, however, longer intervals between mammograms would suffice. "
But how can the individual breast cancer risk of a woman be determined? For this prediction, scientists have developed mathematical models.
The models are based primarily on data from the history of reproduction: at what age did the first menstrual period take place? When was the first child born, how many children were there in total? When did the menopause occur? Was hormonal contraception or hormone replacement therapy taken? The body mass index is also included in the current models for risk assessment, as well as the number of cancer cases in direct relatives.
Annika Hüsing from the department of Rudolf Kaaks has recently shown that the models are even more accurate when the hormone levels are taken into account. This is true at least for postmenopausal women.
For this work, the scientist used blood samples from participants in the EPIC study - the major European study on diet, lifestyle and cancer. The concentrations of the sex hormones estradiol and testosterone, which were determined in these samples, flowed into the model and significantly improved the predictive power.
Further improve screening screening for cancer screening
The predictive models are not designed for women who are known to mutate the famous "breast cancer genes" BRCA1 and BRCA2, and thus have an extremely high risk of developing breast cancer.
In addition to the BRCA mutations, however, there are many tiny gene variants in the genome of every human being, each of which has only a minimal influence on its own. Taken together, however, they can significantly increase the risk of breast cancer.
Scientists are currently assessing the extent of this influence in large international research consortia in which the DKFZ epidemiologists around Kaaks are also involved. These genetic risk profiles should be included as additional biological markers in the models.
It is also important to adapt the calculations to the respective population. Anne Hüsing is in the process of adapting the usual mathematical models, which are based on data from the USA, to German conditions:
"For us women are older when they give birth to their first child and they also have fewer children than women in the US. In addition, the prescription of hormone therapies is handled differently. "
"The challenge now is to bring all these calculations together," says Kaaks, adding, "Screening screening for cancer screening affects millions of people. Therefore, we must constantly check if and how they can be further improved. "(Ad)