TY - JOUR
T1 - Subgroups varying in risk and density highlight the potential for stratified breast cancer screening
AU - Gil Quessep, Eugenio
AU - van der Waal, Danielle
AU - Peters, Jim
AU - Delaloge, Suzette
AU - van Gils, Carla
AU - de Koning, Harry J.
AU - Broeders, Mireille
AU - van Ravesteyn, Nicolien
N1 - Publisher Copyright:
© 2025 The Authors
PY - 2025/2/25
Y1 - 2025/2/25
N2 - Most breast cancer screening programs rely only on demographic data without considering individual risk factors of the population, which might limit their effectiveness by over- and underscreening specific subgroups. Therefore, the aim of this study is to highlight health and economic disparities in outcomes from such a uniform screening strategy. With the microsimulation model MISCAN, we simulated outcomes of the Dutch screening program considering 16 subgroups varying by their 5-year breast cancer risk and breast density. All outcomes showed significant disparities across risk-density subgroups. Notably, women with extremely dense breasts showed a mortality reduction from the current screening of 16–17 % compared to 25–29 % in other groups. Absolute benefits (breast cancer deaths averted, and life-years gained) increased with risk and varied independently by density. The range of false-positive rates varied almost twofold across the span of subgroups and nearly a ninefold difference in the medical costs incurred with lifelong follow-up. These findings emphasize the potential for stratified screening strategies to improve equity in health outcomes and reduce the burden of breast cancer.
AB - Most breast cancer screening programs rely only on demographic data without considering individual risk factors of the population, which might limit their effectiveness by over- and underscreening specific subgroups. Therefore, the aim of this study is to highlight health and economic disparities in outcomes from such a uniform screening strategy. With the microsimulation model MISCAN, we simulated outcomes of the Dutch screening program considering 16 subgroups varying by their 5-year breast cancer risk and breast density. All outcomes showed significant disparities across risk-density subgroups. Notably, women with extremely dense breasts showed a mortality reduction from the current screening of 16–17 % compared to 25–29 % in other groups. Absolute benefits (breast cancer deaths averted, and life-years gained) increased with risk and varied independently by density. The range of false-positive rates varied almost twofold across the span of subgroups and nearly a ninefold difference in the medical costs incurred with lifelong follow-up. These findings emphasize the potential for stratified screening strategies to improve equity in health outcomes and reduce the burden of breast cancer.
KW - Breast density
KW - Breast neoplasms
KW - Computational modeling
KW - Cost of illness
KW - Early detection of cancer
KW - Mammography
KW - Netherlands
KW - Population health
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=85214579905&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2025.115220
DO - 10.1016/j.ejca.2025.115220
M3 - Article
AN - SCOPUS:85214579905
SN - 0959-8049
VL - 217
JO - European Journal of Cancer
JF - European Journal of Cancer
M1 - 115220
ER -