In the UK, the National Institute for Health and Care Excellence (NICE) recommends that women at moderate or high risk of breast cancer be offered risk-reducing medication and enhanced breast screening/surveillance. In June 2022, NICE withdrew a statement recommending assessment of risk in primary care only when women present with concerns. This shift to the proactive assessment of risk substantially changes the role of primary care, in effect paving the way for a primary care-based screening programme to identify those at moderate or high risk of breast cancer.
This new article reviews the literature surrounding proactive breast cancer risk assessment within primary care against the consolidated framework for screening. The authors ﬁnd that risk assessment for women under 50 years currently satisﬁes many of the standard principles for screening.
Most notably, there are large numbers of women at moderate or high risk currently unidentiﬁed, risk models exist that can identify those women with reasonable accuracy, and management options offer the opportunity to reduce breast cancer incidence and mortality in that group.
However, there remain a number of uncertainties and research gaps, particularly around the programme/system requirements, that need to be addressed before these beneﬁts can be realised.
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Juliet A. Usher-Smith, Sarah Hindmarch, David P. French, Marc Tischkowitz, Sowmiya Moorthie, Fiona M. Walter, Rebecca A. Dennison, Francisca Stutzin Donoso, Stephanie Archer, Lily Taylor, Jon Emery, Stephen Morris, Douglas F. Easton and Antonis C. Antoniou: Proactive breast cancer risk assessment in primary care: a review based on the principles of screening. British Journal of Cancer. 03 Feb 2023.