Five-year absolute risk-based and age-based breast cancer screening in the USA

General mammography screening guidelines target women at average risk within a specified age range (age based) and do not consider absolute risk of individual women at a given age. A decision analytical model used 2 established Cancer Intervention and Surveilland Modeling Network (CISNET) breast cancer models and simulated US women born in 1980 who were aged 40 years of older without a history of breast cancer to compare outcomes of mammography screening strategies that vary by 5-year risk of invasive breast cancer versus age-based strategies. In this decision analytical model, 9 risk-based screening strategies were associated with a comparable or greater number of averted breast cancer deaths than biennial age-based screening from ages 40 to 74 years (B40-74) and reduced false-positive recalls by 8% to 23%. For example, compared with B40-74, a risk-based strategy would be associated with 6% more averted breast cancer deaths and 13% fewer false-positive recalls per 1000 women. The authors conclude that this study suggests that risk-based mammography screening using 5-year absolute risk may be associated with improved breast cancer mortality outcomes and reduced harms compared with age-based screening approaches.