Women who are screened for breast cancer will receive greater tailored preventative intervention following the advancements of Prevent Breast Cancer’s PROCAS study. It was introduced with the aim of revolutionising the breast screening process, so that women who go for breast screening would be provided with more information on their own personal risk of developing breast cancer. They would also be offered possible treatments if necessary, as well as advice on how to reduce their risk.
Back in 2009, we launched PROCAS (Predicting the Risk of Cancer at Screening), the largest recruiting research study in the UK. Breast screening is currently a one-size-fits-all procedure, with all women being offered the same standardised tests – despite the fact that some women are more likely to develop breast cancer than others.
The initial phase of the study, PROCAS 1, recruited 57,900 women between 46-73 years of age over the course of six years. It focused on women in Greater Manchester who were about to go for their invited mammogram, gathering additional details about their current health, hormones (including the age of their first period, pregnancies, and menopause), and their dietary and lifestyle choices. Their breast density was also taken into consideration, as women with high breast density are up to six times more likely to develop breast cancer.
For several years, our researchers have been studying Single Nucleotide Polymorphism (known as SNPs), which are small gene fragments that are known to increase a woman’s risk of developing breast cancer. 10,000 of the PROCAS 1 participants gave a saliva sample so that their SNPs could be analysed. Using this information, in addition to the questionnaire and the breast density results, our researchers were able to calculate the individual risk score.
The project – led by Professor Gareth Evans – was a success, with 94 per cent of the women who participated wanting to find out their personal risk score. The overwhelmingly positive response really highlighted the need for more tailored breast screening programmes – a woman may receive a negative mammogram, but still be at a higher risk of developing cancer, so a tailored screening would equip them with the information they need to stay healthy and reduce their risk.
The second phase of the project was launched in 2017, running for three years. This time, the study assessed whether it was possible to calculate the risk score at a woman’s first mammogram. Conducted at five screening sites across Greater Manchester, Cheshire and Lancashire, it involves a further 18,600 women. Whereas it took one to three years to provide women with their risk score during the first phase of the study, PROCAS 2 aimed to provide participants with their risk score within just six weeks. By running the project for three years, we will be able to fully assess its potential and identify the wider impact it would have on patients, NHS staff and other related organisations, such as breast cancer charities.
Professor Evans, who is also a Consultant of Medical Genetics and Cancer Epidemiology at Saint Mary’s Hospital and The University of Manchester, said: “Screening and predicting a woman’s risk of breast cancer is largely based on standard risk factors, such as their age, weight, family history, and other characteristics.
“This research shows that risk prediction is incrementally improved as you combine these factors with information on their breast density, and common genetic variations many of us carry that are known to increase risk.
“This combined method gives women a much clearer picture on how likely they are to develop breast cancer, possible treatments to reduce their risk, and if it does develop, how likely it will respond to different treatments.”
Using this research, we can move towards an approach to breast screening that is tailored to each woman, and alter screening frequency to match each woman’s personal risk. The findings of the study show that we can gain a more in-depth understanding of a woman’s risk, which will change how we currently screen people – for example, by offering more regular screening, or preventative drugs or surgery. The latest research has been picked up by publications including ITV, Metro and the Daily Mail. As well as appearing on BBC Breakfast.
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