Dense breasts or breast cancer in the family? What screening changes mean for you

Breast cancer screening in Australia is set to undergo significant changes over the next decade. The new approach will move away from age-based screening and instead personalize the process based on individual risk factors. These factors could include breast density, family history of breast or ovarian cancer, genetic tests, and even artificial intelligence (AI).

Currently, the BreastScreen program only recommends annual screenings for women with a strong family history of breast or ovarian cancer. However, this is set to change as more risk information becomes available and accessible.

One key factor that could influence screening is breast density. Dense breasts can make it more difficult to detect cancer on a mammogram, and women with dense breasts are at a higher risk of developing breast cancer. The current BreastScreen program notifies all women of their breast density during screening and provides guidance for GPs when consulting with women who have dense breasts.

However, there are questions about how to best communicate this risk to women and whether they can access additional imaging methods such as 3D mammography, contrast-enhanced mammography, or MRI.

Online risk assessment tools like iPrevent and CanRisk combine breast density information with other risk factors to calculate an individual's breast cancer risk. These tools can help inform discussions between women and their healthcare providers about the best strategies for managing individual risk. Genetic tests can also be used to calculate an individual's polygenic risk score, which identifies those at increased risk of breast cancer. This could be particularly useful for younger women who could benefit from earlier screening.

Artificial intelligence (AI) is another potential tool that could be used in breast cancer screening. AI could help interpret mammography images, detect cancer, and predict future risk, which could help reduce the workload of radiologists and determine who should be recalled for further assessment. An AI model trained using Australian data is currently being tested in BreastScreen Victoria and will soon be tested in South Australia.

However, there are still barriers to implementing these new risk-stratified screening methods. Pathways for obtaining and using risk information need to be developed, and effective communication strategies need to be established for both women and healthcare professionals. Pilot studies will be needed to test the acceptability and feasibility of these pathways before large-scale implementation.

Despite these challenges, Australia plans to phase in risk-stratified breast screening over the next 10 years, starting with biennial mammograms for women over 40 and continuing with regular screenings as outlined in the current program. Meanwhile, women are advised to have their next mammogram when due, undergo free mammograms every two years if they are over 40, and see their doctor as soon as possible if they experience any new breast symptoms.