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Breast cancer screening in an era of personalized regimens: A conceptual model and National Cancer Institute initiative for risk‐based and preference‐based approaches at a population level
Author(s) -
Onega Tracy,
Beaber Elisabeth F.,
Sprague Brian L.,
Barlow William E.,
Haas Jennifer S.,
Tosteson An.A.,
D. Schnall Mitchell,
Armstrong Katrina,
Schapira Marilyn M.,
Geller Berta,
Weaver Donald L.,
Conant Emily F.
Publication year - 2014
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28771
Subject(s) - overdiagnosis , medicine , breast cancer , breast cancer screening , population , health care , cancer screening , mammography , precision medicine , cancer , personalized medicine , family medicine , environmental health , bioinformatics , pathology , economics , economic growth , biology
Breast cancer screening holds a prominent place in public health, health care delivery, policy, and women's health care decisions. Several factors are driving shifts in how population‐based breast cancer screening is approached, including advanced imaging technologies, health system performance measures, health care reform, concern for “overdiagnosis,” and improved understanding of risk. Maximizing benefits while minimizing the harms of screening requires moving from a “1‐size‐fits‐all” guideline paradigm to more personalized strategies. A refined conceptual model for breast cancer screening is needed to align women's risks and preferences with screening regimens. A conceptual model of personalized breast cancer screening is presented herein that emphasizes key domains and transitions throughout the screening process, as well as multilevel perspectives. The key domains of screening awareness, detection, diagnosis, and treatment and survivorship are conceptualized to function at the level of the patient, provider, facility, health care system, and population/policy arena. Personalized breast cancer screening can be assessed across these domains with both process and outcome measures. Identifying, evaluating, and monitoring process measures in screening is a focus of a National Cancer Institute initiative entitled PROSPR (Population‐based Research Optimizing Screening through Personalized Regimens), which will provide generalizable evidence for a risk‐based model of breast cancer screening, The model presented builds on prior breast cancer screening models and may serve to identify new measures to optimize benefits‐to‐harms tradeoffs in population‐based screening, which is a timely goal in the era of health care reform. Cancer 2014;120:2955–2964. © 2014 American Cancer Society .