Risk-adjusted breast screening: an Australian perspective and considerations for the Western Pacific.

Nickson, Carolyn; Velentzis, Louiza S; Mann, G Bruce; Grogan, Paul; Bateson, Deborah; Canfell, Karen · Lancet Reg Health West Pac · 2025

review · Level V

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Abstract

Breast cancer is the most common cancer in females globally, and the leading cause of female cancer deaths. The 2023 World Health Organisation Global Breast Cancer Initiative Framework aims to prevent 2·5 million deaths from breast cancer by 2040. Early detection of breast cancer is central to this goal, and population-based breast screening is key to early detection. A more risk-adjusted approach to screening within current target age ranges, whether risk-stratified (tailoring population-wide screening protocols based on risk) or risk-targeted (prioritising available screening services to higher risk females) is likely to prevent further deaths. This article presents a review of the risk-adjusted screening initiative in Australia (the Roadmap to Optimising Screening in Australia (ROSA) Project) and explores a potential framework for advancing risk-adjusted strategies for breast screening throughout the Western Pacific region.