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July 5, 2018

Implementation Challenges for Risk-Stratified Screening in the Era of Precision Medicine

Author Affiliations
  • 1Division of Cancer Control and Population Sciences, The National Cancer Institute, Rockville, Maryland
JAMA Oncol. Published online July 5, 2018. doi:10.1001/jamaoncol.2018.1940

Cancer screening tests are generally recommended when the benefits (eg, morbidity or mortality reduction) outweigh the risks (eg, overtreatment). In the era of precision medicine, the aim is to more precisely measure these benefits and risks by accounting for individual-level patient characteristics. The premise for precision prevention in oncology is that an individual’s risk, related to genetics, environment, and lifestyle factors, is associated with the level of benefit received from cancer screening.1 Under this framework, risk stratification for cancer screening can be used to identify and recommend screening for those whose cancer risk is high enough that the benefits outweigh potential harms. In the case of breast cancer, identifying this subgroup could be important in providing high-quality prevention and care because evidence demonstrates that while breast cancer screening reduces mortality, it also exposes women to potential harms related to overdiagnosis—–ie, diagnosis of a cancer that would not have caused sickness or death regardless of screening.2

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