How data transform screening: Challenges and opportunities for risk-based cancer screening

Abstract

Evidence-based cancer screening guidelines recommend screening when the evidence shows that benefits outweigh harms at a reasonable cost. These recommendations apply to broad sex- and age-specific population groups. However, there is a substantial heterogeneity in cancer risk and expected screening benefits within age- and sex-strata. Further, screening is often done in strata of the population, e.g., older adults, for which there is no evidence of benefits, and that can be considered as a form of low-value prevention. Risk-based approaches to screening tailor screening eligibility and modalities (test types, frequency, follow-up) to individual estimates of cancer risk and prognosis, aiming to improve the balance of benefits and harms while accounting for limited public health resources. These approaches have grown in popularity, notably following the 2022 European Council Recommendation on cancer screening, encouraging their adoption. In this presentation, taking the case of prostate cancer, we will discuss how data is changing screening practices, opening opportunities for personalized screening, but also what are major challenges of the risk-based approach (i.e., determining and modeling the risk of cancer, preventing growing inequities in screening access and cancer outcomes, and demonstrating efficacy compared to the standard approach) that have to be addressed before its implementation.