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Breast cancer screening - from one-size-fits-all to a personalised risk-based approach

Projectomschrijving

Vroege ontdekking van borstkanker via screening levert een belangrijke bijdrage aan het verlagen van de borstkankersterfte, maar heeft ook nadelen. Wij onderzoeken of het bevolkingsonderzoek effectiever en doelmatiger kan worden door rekening te houden met de individuele kans van een vrouw op borstkanker.

Door informatie te verzamelen over zoveel mogelijk risicofactoren bij 90000 vrouwen die deelnemen aan screening kunnen we voor iedere vrouw een schatting maken van haar risico op borstkanker. Dan kunnen we de deelnemers verdelen in vrouwen met een hoog of laag risico. Met computermodellen gaan we berekenen wat het effect is als we de hoog-risico groep een intensief screeningsbeleid zouden aanbieden, terwijl de laag-risico groep juist minder intensief gescreend zou worden. Daarnaast willen we in kaart brengen hoe acceptabel screening ‘op maat’ is voor vrouwen en medisch specialisten en welke rol ethische, psychologische, juridische, logistieke en financiële aspecten daarbij spelen.

Producten

Titel: Feedback and thoughts on how current knowledge could be used to personalise prevention in different settings over the next 5 years: screening perspective.
Auteur: Mireille Broeders
Titel: Bevolkingsonderzoek, pleidooi voor screenen op maat
Auteur: Mireille Broeders
Titel: Are we ready for the challenge to implement personalised risk-based breast cancer screening and primary prevention?
Auteur: Linda Rainey, Daniëlle van der Waal, Anna Jervaeus, Yvonne Wengström, Gareth Evans, Louise Donnelly, Mireille Broeders
Titel: Women’s perceptions of personalised risk-based breast cancer screening and primary prevention: a systematic review
Auteur: L. Rainey, D. van der Waal, Y. Wengström, A. Jervaeus, M.J.M. Broeders
Titel: Breast density and risk assessment in Dutch screening
Auteur: Mireille Broeders
Titel: Personalized breast cancer screening and the role of breast density
Auteur: Mireille Broeders
Titel: Personalised breast cancer screening: from one-size-fits all to a risk-based approach
Auteur: Mireille Broeders
Titel: Communicating risk to healthy individuals
Auteur: Mireille Broeders
Titel: Personalised screening
Auteur: Mireille Broeders
Titel: BNR radiodebat – Big Data
Auteur: Mireille Broeders
Titel: Personalised screening
Auteur: Mireille Broeders
Titel: Personalised breast cancer screening: from one-size-fits all to a risk-based approach
Auteur: Mireille Broeders
Titel: How to define risk groups
Auteur: Mireille Broeders
Titel: Personalised breast cancer screening: from one-size-fits all to a risk-based approach
Auteur: Mireille Broeders
Titel: Women’s perceptions of personalised risk-based breast cancer screening and prevention: a cross-cultural focus group study
Auteur: Linda Rainey, Anna Jervaeus, Louise S. Donnelly, D. Gareth Evans, Mattias Hammarström, Per Hall, Yvonne Wengström, Mireille J M Broeders, Daniëlle van der Waal
Titel: Op maat screenen
Auteur: Mireille Broeders
Titel: Personalized screening for breast cancer: perceptions among women and health professionals
Auteur: Mireille Broeders
Titel: PRISMA study
Auteur: Mireille Broeders
Titel: Women’s perceptions of personalised risk-based breast cancer screening and primary prevention: a systematic review
Auteur: L. Rainey, D. van der Waal, Y. Wengström, A. Jervaeus, M.J.M. Broeders
Titel: Bijdrage aan bijeenkomst Bevolkingsonderzoek Midden-West
Auteur: Mireille Broeders
Titel: www.prisma-studie.nl
Auteur: Mireille Broeders, Linda Rainey, Daniëlle van der Waal, Jos van Dijk
Link: http://www.prisma-studie.nl
Titel: European women’s perceptions of the implementation and organisation of risk-based breast cancer screening and prevention: a qualitative study
Auteur: Linda Rainey, Daniëlle van der Waal, Anna Jervaeus, Louise S. Donnelly, D. Gareth Evans, Mattias Hammarström, Per Hall, Yvonne Wengström & Mireille J. M. Broeders
Magazine: BMC Cancer
Titel: Women's decision-making regarding risk-stratified breast cancer screening and prevention from the perspective of international healthcare professionals
Auteur: Linda Rainey, Daniëlle van der Waal, Louise S Donnelly, D Gareth Evans, Yvonne Wengström, Mireille Broeders
Magazine: PLoS ONE
Titel: The impact of alcohol consumption and physical activity on breast cancer: The role of breast cancer risk
Auteur: Linda Rainey, Mikael Eriksson, Thang Trinh, Kamila Czene, Mireille J.M. Broeders, Daniëlle van der Waal, Per Hall
Magazine: International Journal of Cancer
Titel: Onderzoek op maat naar 'knobbeltje'
Auteur: Maarten Dooper
Magazine: Brabants Dagblad
Titel: Onderzoek op maat naar 'knobbeltje'
Auteur: Maarten Dooper
Magazine: BN De Stem
Titel: Dutch women’s intended participation in a risk-based breast cancer screening and prevention programme: a survey study identifying preferences, facilitators and barriers
Auteur: Linda Rainey, Daniëlle van der Waal & Mireille J. M. Broeders
Magazine: BMC Cancer
Titel: Onderzoek op maat naar 'knobbeltje'
Auteur: Maarten Dooper
Magazine: De Gelderlander
Titel: Are we ready for the challenge of implementing risk-based breast cancer screening and primary prevention?
Auteur: Linda Rainey, Daniëlle van der Waal, Anna Jervaeus, Yvonne Wengström, D. Gareth Evans, Louise S. Donnelly, Mireille J.M.Broeders
Magazine: Breast
Titel: Women’s health behaviour change after receiving breast cancer risk estimates with tailored screening and prevention recommendations.
Auteur: Linda Rainey, Daniëlle van der Waal, Louise S. Donnelly, Jake Southworth, David P. French, D. Gareth Evans & Mireille J. M. Broeders
Magazine: BMC Cancer
Titel: Onderzoek op maat naar ‘knobbeltje’
Auteur: Maarten Dooper
Magazine: Eindhovens Dagblad
Titel: Maak je eigen afweging
Auteur: Mireille Broeders
Magazine: Gezondgids
Titel: Women’s perceptions of the adoption of personalised risk-based breast cancer screening and primary prevention: a systematic review
Auteur: Linda Rainey, Daniëlle van der Waal, Yvonne Wengström, Anna Jervaeus & Mireille J.M. Broeders
Magazine: Acta Oncologica
Titel: Women's perceptions of personalized risk-based breast cancer screening and prevention: An international focus group study
Auteur: Linda Rainey, Anna Jervaeus, Louise S. Donnelly, D. Gareth Evans, Mattias Hammarström, Per Hall, Yvonne Wengström, Mireille J.M. Broeders, and Daniëlle van der Waal
Magazine: Psychooncology
Titel: Personalized screening
Auteur: Mireille Broeders
Magazine: Oncologie Up-to-date
Titel: Risk-based breast cancer screening and prevention: opportunities and challenges.
Auteur: Linda Rainey

Verslagen


Samenvatting van de aanvraag

OVERALL AIM Personalised risk-based screening for breast cancer can help target screening to women who will get the greatest benefit while sparing costs and complications among women who would experience little benefit. RESEARCH QUESTIONS Objective 1: To collect information on risk factors and biomarkers in a screening cohort, develop a tailor-made risk prediction model and, subsequently, model the impact of adapting breast cancer screening policy to populations at varying levels of risk, i.e. to assess whether moving from the current ‘one-size-fits-all’ screening policy to more personalised risk-based screening regimens can optimise the efficacy of breast cancer screening using the same resources. Objective 2: To make an inventory on communication, medico-legal and ethical considerations related to personalised risk-based screening and present a synthesis at an interdisciplinary expert meeting, along with results of the project, in order to discuss implications and recommendations for current vs personalised risk-based screening policies. RATIONALE Although historically the benefits of screening have been emphasised, it is increasingly apparent that recommendations regarding breast cancer screening should also consider a careful evaluation of potential harms. Harms, such as the occurrence of false screening outcomes, can have a significant impact on a screenee’s quality of life. Moving from the current ‘one-size-fits-all’ screening policy to personalised risk-based screening approaches can potentially optimise the efficacy of breast cancer screening, by maximising its life-sparing effect and minimising side effects. The recent transition from analogue to digital screening mammography in the Netherlands offers the unprecedented opportunity to include an automated breast density assessment for each screening examination. Breast density is one of the strongest risk factors for breast cancer, but so far missing in many risk prediction models. Further, new opportunities are currently arising that allow information on blood hormones and genetic variants to be added to risk prediction models. In combination with information on established risk factors, such as reproductive factors and body mass index, this provides an excellent setting to evaluate the utility of risk stratification to identify subsets of the population in order to optimise the current screening policy for breast cancer using the same resources. PLAN OF INVESTIGATION The Dutch screening programme for breast cancer offers biennial mammography to women in the age group 50 to 75 years. We aim to recruit 90,000 participants among women attending for screening (more than 900,000 screening examinations per year). Participants will be asked to complete a web-based questionnaire on all currently established risk factors for breast cancer. In addition, we will ask women to provide a blood sample in order to determine plasma hormone levels, other blood markers and to extract DNA for genotyping (aim: 30,000 samples). Breast density will be automatically assessed on the unprocessed screening mammograms. This empirical data will be used to evaluate the risk prediction performance of various prediction models, based on the Gail and Tyrer-Cuzick model, using analysis of receiver operator characteristic curves as well as decision-analytic measures. In the next step we will extend the analytical approach recently published by Pashyan et al to investigate the implications for personalised screening based on a comprehensive risk profile versus age alone. In addition, cost-effectiveness of personalised screening regimens will be investigated using the well-established MISCAN model. Extending the personalised paradigm to the field of breast cancer screening will raise additional questions with respect to communication, medico-legal and ethical considerations. These topics will be inventoried by a multidisciplinary working group and discussed, along with a presentation of the results of this project, at an interdisciplinary expert meeting. ORIGINALITY AND INNOVATIVE ASPECTS The current ‘one-size-fits-all’ screening approach does not take advantage of the growing ability to predict individual variation in screening benefits and harms and to translate that information into better screening outcomes. In this project, we will be able to model the impact of adapting breast cancer screening policy to a woman’s individual risk by collecting all relevant data on risk factors and obtaining a blood sample from the participants. This project thus represents an essential first step towards the future, where more individualised approaches to screening are likely to become the new screening paradigm. RELEVANCE TO TOP PREVENTION PROGRAMME Breast cancer continues to be an important health care problem. This project should provide the 'proof of principle' for the personalised risk-based approach which aims to optimize the current screening policy.

Onderwerpen

Kenmerken

Projectnummer:
200500004
Looptijd: 100%
Looptijd: 100 %
2013
2022
Onderdeel van programma:
Projectleider en penvoerder:
Dr. M.J.M. Broeders