Objective:

To examine the discrepancies in breast cancer risk assessment models and their implications for MRI screening recommendations.

Approach:

Key Findings:

• 5.6% of women exceed the 20% lifetime breast cancer risk threshold using the Tyrer-Cuzick model, compared to 0.4% to 0.9% with other models.
• Discrepancies in risk assessment models and thresholds (20% vs. 25% vs. 1.67%) create confusion in clinical decision-making.
• Automated risk scores may reach patients before clinician validation, leading to potential misinterpretations.

Interpretation:

There is no consensus on which risk model or threshold defines high risk, and the clinical implications of automated risk scores require careful validation.

Limitations:

• Lack of consensus on risk models and thresholds.
• Insufficient data comparing mortality between different screening intervals.
• Prevention medications have not demonstrated a reduction in mortality.

Conclusion:

The authors advocate for confirming inputs before acting on radiology-generated scores and suggest the formation of interdisciplinary groups to address model and threshold standardization.

Sources:

• JAMA Internal Medicine
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