Background
death, breast cancer, cancer, Breast cancer, tumour
CANCER, BREAST CANCER, TUMOUR, BREAST CANCER
Breast cancer is the most common cancer and a leading cause of female death in the UK, especially at younger ages [Comprehensive risk assessment in the NHSBSP could identify many of the 5 in 6 women who are at National Institute for Health and Care Excellence (NICE) for England & Wales defined high risk [NICE recommended in 2013 that women at high risk of breast cancer (lifetime risk ≥30%, 10-year risk ≥8%), should be offered annual breast screening between the ages of 40–59 years; and those at moderate risk (lifetime risk=17–29%, 10-year risk=3–7.9% aged 40 years), should be offered annual mammograms from 40–49 years [We developed a partially automated system (BC-Predict) for offering breast cancer risk assessment and stratification to women when they accept their invitation for an NHSBSP mammogram, which included a risk factor questionnaire, volumetric mammographic density analysis and feedback letters of risk level to both the women and their primary care practitioners. A development phase involved working with healthcare professionals to ensure that the care pathways were workable and achievable [The introduction of risk stratification in the NHSBSP could facilitate the potential benefits of more frequent annual mammography (potentially lowering tumour stage) and/or preventive medication in those at increased risk to be realised on a population basis. This would also potentially allow women at lower risk to have less frequent mammography. In principle, a risk-stratified NHSBSP should result in a better balance of benefits, harms and costs to the NHS and there is some early evidence to support this premise [The consequences of actually introducing risk stratified screening as part of routine practice in the NHSBSP remain unclear. In the PROCAS-1 study, communication of risk estimates occurred 3–5years after women provided their consent and questionnaire information [The present study aimed to quantify these likely benefits and harms of introducing risk-stratified screening in the NHSBSP [