Projects / Programmes
Development and implementation of personalised breast cancer risk evaluation tool for Slovenian population
| Code |
Science |
Field |
Subfield |
| 3.08.00 |
Medical sciences |
Public health (occupational safety) |
|
| Code |
Science |
Field |
| B680 |
Biomedical sciences |
Public health, epidemiology |
| Code |
Science |
Field |
| 3.03 |
Medical and Health Sciences |
Health sciences |
breast cancer, risk factors, risk assessment models, national guidliness and regulation for early detection of breast cancer, preventive mammography
Researchers (14)
Organisations (1)
| no. |
Code |
Research organisation |
City |
Registration number |
No. of publicationsNo. of publications |
| 1. |
0302 |
Institute of Oncology Ljubljana |
Ljubljana |
5055733000 |
15,472 |
Abstract
BACKGROUND
Procedures for breast cancer screening for women who are not included in the National screening program for breast cancer – Dora are defined in the national Terms of the health prevention at the primary health care level (Pravilnik za izvajanje preventivnega zdravstvenega varstva na primarni ravni). It is outdated in many points, and above all it is very vague. We perceive that many women are referred for screening mammoghaphy unnecessarily and too often, which in addition to the excess burden of women, also leads to unnecessary costs and increase waiting times in the breast units.
Experiences from the UK's National Health System (NHS) show that the use of population-specific tools for numerically determining a personalised risk of breast cancer facilitates and standardizes referrals of asymptomatic women to breast cancer screening. English clinical guidelines for assessment of women at higher risk for breast cancer (NICE guidance) provide criteria for the division of the population into groups according to their individual risk. Each of the group (population, moderate and high risk) is considered in the separate algorithms.
Tyrer-Cuzick algorithm that is included in the program IBIS is currently known as the most accurate model for assessing a personalised risk of breast cancer. It is an upgrade of the most widely used program BOADICEA. In addition to family history data and population risk of breast cancer IBIS applies also personal characteristics such as reproductive factors and previous medical diagnosis.
AIMS AND OBJECTIVES
The primary purpose of the project is to provide evidence-based identification and assessment of those Slovenian women who are at increased breast cancer risk because of recognised risk factors. . Decisions concerning the referrals of higher risk women to the Breast units for preventive mammographies or in the Clinic for cancer genetic counselling will be more accurate, easier, and unified at the national level. From professional and organizational point of view, we propose that the use of the software tool may be incorporated in the relevant terms, guidelines and regulations, and therefore this is a key part of the project. We will prepare expert recommendations that may be used for updating the existing national Terms of the health prevention at the primary health care level and existing National guidelines of diagnosis and treatment of breast cancer.
The specific objectives of the project are:
• development of a software tool S-IBIS for determining individual breast cancer risk in the Slovenian population on the basis of Tyrer-Cuzick algorithm and prepare instructions for its use in clinics;
• pilot testing of the new application S-IBIS in the breast units and clinics, evaluation of the effect that the introduction of new working tool has on the existing work processes and evaluation of an impact of the use of software tool on further assessment/screening procedures;
• development of a clinical pathway for classification and further assessment/screening of asymptomatic Slovenian women based on the calculated personalised breast cancer risk and participation in inclusion of the pathway in the Terms of the health prevention at the primary health care level.
CONTENTS
In the algorithm of the Tyrer-Cuzick IBIS program we will incorporate the information of the Slovenian general population breast cancer risks, so new software tool for calculation of a personalised breast cancer risk will be adapted to Slovenian population breast cancer risks. Key population data will be obtained from the Cancer Registry of Republic of Slovenia. The program S-IBIS will be tested on a sample of asymptomatic women who are also younger than 50 years and are therefore not invited in the National screening program for breast cancer - DORA, but are recognised under the current Terms of the health prevention at the primary health care level as moderate or high risk for breast cancer and are theref
Significance for science
1. ENABELING PERSONALISED BREAST CANCER RISK CALCULATION IN EVERYDAY PRACTICE
In Slovenia, breast cancer risk for general population is well known, but until now no tool for personalised breast cancer risk evaluation based on woman’s family history and other risk factors has been available. S-IBIS software program, that will be developed and implemented during proposed project, will enable evidence based classification of an asymptomatic individuals into three risk groups; population, moderate and high breast cancer risk group. S-IBIS may become a crucial professional tool for tailored further preventive actions in the assessment of higher risk women.
2. SCIENTIFICALLY AND PROFFESIONALY UPDATED NATIONAL GUIDELINES AND REGULATIONS FOR EARLY BREAST CANCER DETECTION
Terms of the health prevention at the primary health care level (Pravilnik za izvajanje preventivnega zdravstvenega varstva na primarni ravni) defines higher risk women based only on a few qualitative criteria, while existing national Breast cancer diagnostic and treatment guidelines use quantitative risk definitions by Claus, which do not refer to adequate population or individual risk. During the proposed project clinical pathways for breast cancer screening for women at higher risk will be specified and integrated in the National guidelines of diagnosis and treatment of breast cancer. Decision makers will be advised how to include these clinical pathways reasonably also into the Terms of the health prevention at the primary health care level. Updated instructions for preventive measures regarding early breast cancer detection in higher risk women will be based on quantitative facts, in accordance with scientific findings, and will be nationally coordinated.
Significance for the country
1. MORE EFFECTIVE PREVENTIVE HEALTH CARE FOR WOMEN
Considering the defined and evidence based scientific recommendations for early breast cancer detection among asymptomatic Slovenian women, women who are too young to be invited in the organized breast screening program DORA, will be referred for preventive mammographies to Breast units or to the genetic counselling according to nationally standardized procedures. The number of unnecessarily performed preventive interventions will decrease, at the same time waiting times for preventive examinations for moderate and high-risk women will be reduced. In fact, young breast cancer patients will be diagnosed at an earlier cancer stage and consequently individual and population breast cancer survival will be improved.
2. REDUCED COSTS FOR DIAGNOSTICS AND TREATMENT
The decrease in unnecessary preventive mammographies and genetic counselling procedures will effect in health fund savings, which can be even greater with the reduction of further assessment procedures after false positive mammographies (10 – 15% of all mammographies). Early breast cancer detection due to preventive mammography results in smaller breast tumours and consequently in lower expenses (less invasive treatment and less rehabilitation).
3. REDUCED ABSENCE FROM WORK IN THE LABOUR MARKET
Project target group are asymptomatic women mainly under 50 years of age, majority of them still economically active. It is expected that more effective prevention can result in reduced absenteeism in the workplace; less women will be referred to unnecessary diagnostic assessment, their stress and anxiety will be reduced and nevertheless, newly diagnosed patients' treatment of early stage breast cancer will be less invasive and more effective with shorter absence from work.
4. NATIONAL BREAST CANCER SCREENING PROGRAMME - DORA EXPANSION BACKGROUND
It is questionable how to identify women at higher breast cancer risk who need regular preventive mammographies before the age of 50. In fact, expansion of the target population in the National breast screening program DORA is very reasonable. Currently, Program DORA invites women between 50 and 69 years. Screening program infrastructure is complex and one of the most efficiently designed health care structure in the Slovenian health care system. It is conducted in accordance with European guidelines and standardized protocols for quality assurance. High-quality health services within the Program DORA are very appropriate for higher risk women's follow-up, too. In the future, the results of this project can be implemented in the Program DORA and can establish so called tailored (personalised) screening, an upcoming trend in other European countries, too.
Most important scientific results
Annual report
2018
Most important socioeconomically and culturally relevant results
Annual report
2016,
2018,
final report
