Individualised Breast Cancer Screening Munich

However, breast cancer is a multifactorial disease. Besides age, several additional risk factors are relevant. These include a family history of breast or ovarian cancer or the presence of a pathogenic variant in one of 18 known high-risk or moderate-risk genes associated with hereditary breast cancer. The most well-known gene loci include BRCA1 and BRCA2. According to recent research, so-called genetic modifiers also play an important role. These represent numerous genetic variants which, in combination, can increase – or decrease – breast cancer risk. Lifestyle factors also play a significant role, including physical inactivity, overweight, unhealthy diet, smoking, alcohol consumption, and a woman’s hormonal profile (age at first menstruation, age at first childbirth, age at menopause, and duration/dosage of hormone replacement therapy or oral contraceptive use).

Although breast cancer is the most common cancer among women, it is not the most fatal. When detected and treated early, most cases are curable. Mortality has been steadily declining for decades. While over 18,000 women die of breast cancer each year, around 87 percent of all women with a breast cancer diagnosis are still alive five years later.

This positive trend is due to improved early detection – allowing tumours to be identified at earlier, more treatable stages – as well as advances in therapy. Surgical, radiotherapeutic, and medical treatments are now more targeted, personalised, and often less burdensome than in the past. Moreover, interdisciplinary care in certified centres is now standard in breast cancer treatment.

To make early detection as effective as possible, screening should be adapted to an individual’s personal risk.

1. For women in the general population, the established standard is the national mammography screening programme for women aged 50 to 69, offered every two years.
2. Women with a family history or very early cases of cancer, who meet the criteria for hereditary breast and ovarian cancer, are offered genetic counselling and testing (see Figure 1). Depending on the results, they may be enrolled in specialised, intensive surveillance programmes at certified centres for hereditary breast and ovarian cancer (FBREK centres). Current data show a proven survival benefit for women participating in these surveillance programmes.
3. For women under 50 who are not yet part of the mammography screening programme and do not qualify for genetic testing, the question arises whether early imaging-based surveillance is advisable. This decision should be based on the individual risk of developing breast cancer.

In England, recommendations for breast cancer screening already differentiate between risk categories. Women with a lifetime breast cancer risk below 17% or a 10-year risk under 3% should follow the general mammography screening programme. If the lifetime risk is 17–30% (or a 10-year risk of 3–8%), screening should begin earlier and be conducted annually. Women with a lifetime risk over 30% (10-year risk above 8%) are considered high-risk and should be monitored at specialised centres. The NICE guidelines recommend using a well-calibrated risk model such as BOADICEA to calculate these probabilities.

In Germany, individualised approaches have also been incorporated into recommendations, although they are not yet firmly established and are rarely implemented. The defined lifetime risk thresholds are similar to the English recommendations (see Figure 3 in the appendix).

Using individual risk assessment with BOADICEA—currently the only certified risk calculation programme—we offer the calculation of your personal breast cancer risk and the development of a tailored early detection strategy.