Predicting Risk Of Cancer At Screening (PROCAS): results on the first 10,000 women entered from the Greater Manchester National Breast Screening Programme (NHSBSP)


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Gareth Evans1, Paula Stavrinos2, Sue Astley3, Mary Wilson2, Alan Hufton3, Jane Warwick4, Ruth Warren5, Michelle Harvie2, Barbara Eckersley2, William Newman3, Iain Buchan3, Jack Cuzick4, Anthony Howell6
1Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom,2University Hospital of South Manchester, Manchester, United Kingdom,3University of Manchester, Manchester, United Kingdom,4Wolfson Institute of Preventive Medicine, London, United Kingdom,5University of Cambridge, Cambridge, United Kingdom,6Christie Hospital, Manchester, United Kingdom

Background

Currently the NHS does not identify women at increased risk of breast cancer in the NHSBSP.  The PROCAS study aims to determine breast cancer risk in 60,000 women based on a combination of standard risk factors, mammographic density and relevant single nucleotide polymorphisms (SNPs). This development aims to improve risk estimation and consider using the information to counsel women at high risk and potentially adapt screening interval based on personal risk. Here we report on the first 10,000 women entered.

Method

Women invited for mammography are also invited to PROCAS. This involves completion of risk factor questionnaire and providing a saliva sample for SNP testing. Several methods of estimating mammographic density are being assessed, including visual analogue scale (VAS). Women at high risk (?8% 10year risk or ?5% 10-year risk and ?60% mammographic density [VAS]) are invited for clinical review in our Family History Clinic (FHC). We predict 600 cancers in the total population which will enable us to evaluate the utility of predictive risk algorithms.

Results

Between 11/09-07/10; 44,711 women were invited to attend screening . 67.7% attended screening of which 35% entered PROCAS. Mean mammographic density (VAS) on 9121 women was 29%,7.6% had >59% density. Ten year risk of breast cancer, based on the Tyrer-Cuzick model, ranged from <1% to 15% (median 2.5%). 93% of women wished to know their breast cancer risk. To date, 90 women have been estimated to be at high risk and thus far 68 have been counselled by FHC clinicians. Updated results will be reported.

Conclusion

These initial data indicate that risk determination and counselling within the NHSBSP/FHC organisation is feasible. Data on the projected 60,000 women will enable us to assess whether or not: combining risk factors will improve prediction; fully automated data collection and reporting of risk in this manner is workable within NHSBSP.