Precision screening.

This modeling study seeks to find the most effective breast cancer screening strategy for women with pathogenic mutations in ATM, CHEK2, and PALB2. First up, what are the lifetime risks associated with these mutations? Here they estimate 21% with an ATM mutation, 28% with CHEK2, and 40% with PALB2. If these women got standard annual mammography screening alone starting at age 40, breast cancer mortality is estimated to be reduced by 36-39%. Adding MRI screening starting at age 35 boosted that reduction to 54-58%—at the expense of a lot more unnecessary biopsies, of course. Lowering the age for starting MRI and/or mammograms at age 30 didn’t seem to add much beyond even more benign biopsies. | Lowry, JAMA Oncol 2022