MOVING TOWARDS A PERSONALIZED APPROACH TO BREAST CANCER SCREENING: ARE WE READY?

Abstract

Mammography is widely adopted as the screening tool for early detection of breast cancer, but current age-based approach is not optimized for all women. Recently, a risk-stratified approach based on polygenic risk score (PRS), mammographic density and other risk factors has been proposed. This thesis delineates the cost-effectiveness of Singapore’s age-based screening policy and the acceptability of risk-based screening. Current screening policy at observed attendance level is cost-effective at S$14,344/QALY gained but can be optimized by improving attendance. A review of the cost-effectiveness of risk-based strategies found many knowledge gaps, including accuracy of risk prediction to inform screening algorithms. We then found that PRS information slightly improved discrimination accuracy and overall risk reclassification when added to traditional risk prediction models. Singaporean women are receptive towards PRS testing but expect high test accuracy. Remaining research gaps include clinical validity and utility of risk-based screening algorithms and long-term outcomes of risk-based screening.