AB013. 221. The greater the risk the greater the reward?—development, implementation and evaluation of an elevated breast cancer risk surveillance programme

Background: Women under 50 account for 25% of breast cancer (BC). Currently, there exists no national surveillance programme to screen women who are at an elevated risk of BC.

Methods: A programme was established to evaluate risk in women attending the Cork BC centre offering surveillance to those identified as elevated risk as per the National Institute for Clinical Excellence (NICE) criteria. International measures of screening performance were applied, data collated and analysed from 2013–2018.

Results: A total of 17,838 individual risk assessments were performed during the study period of which 538 women were recruited to the moderate and 153 to the high-risk screening programmes. For the purpose of this study, known genetic carriers were excluded from these categories at recruitment. Attendance was 96% for the 1,546 invitations issued. A total of 18 cancers were identified (15 invasive) giving an overall detection rate of 12 cancers per thousand mammograms performed. The detection rate for BreastCheck in 2017 was 6.8 cancers per 1,000 mammograms. Specifically, the projected detection rate in the high-risk group was 19.6 and moderate group 10 per 1,000 mammograms. Benign radiological recall rate was 9% compared to the BreastCheck rate of 4%. Of the cancers identified in those screened women under 50, 70% were T1 and N0. In matched women diagnosed through the traditional symptomatic programme, 70% were N1.

Conclusions: A targeted surveillance programme directed at women with an elevated risk of BC has high compliance and identifies BC earlier than that diagnosed through the symptomatic service. Identification rates compare favourably with the national screening programme.

Keywords: Breast cancer (BC); screening; surveillance