HIQA to consider ways to include breast density in cancer screenings

HIQA will consider ways in which breast density could be incorporated in screenings

In Ireland, women aged 50 to 69 are eligible for a mammogram every two years as part of BreastCheck, the national population-based breast screening programme. Breast cancer was the most commonly diagnosed invasive cancer and the second leading cause of cancer‑related death among women in Ireland between 2020 and 2022.

However, the HSE currently doesn't report on breast density to women after a BreastCheck screening, even though the risk of breast cancer is higher in women with the densest breasts compared to those with less dense breasts.

The Marie Keating Foundation confirmed that breast density is one of the strongest independent risk factors for developing breast cancer.

It is reportedly stronger than your family history and age.

Today, HIQA published a protocol for a Health Technology Assessment (HTA) examining potential modifications to the BreastCheck programme. This HTA was requested by the National Screening Advisory Committee (NSAC) and will consider ways in which breast density could be incorporated within the BreastCheck screening pathway.

Breast density refers to the proportion of fibroglandular (dense) tissue relative to adipose (fatty) tissue in the breast. Breast density changes over time and is typically higher in younger women. Higher levels of breast density can make tumours more difficult to detect during screening with digital mammography.

Given the impact of breast density on cancer risk and detection, this assessment will consider whether it would be beneficial to measure, record, and notify women attending BreastCheck of their breast density. Women with dense breasts could potentially be offered additional screening tests, such as digital breast tomosynthesis, MRI, contrast-enhanced mammography, or ultrasound.

This assessment will explore the impact on health outcomes of these potential modifications to the programme. Depending on the findings of this assessment, further work may be undertaken to assess the economic and organisational implications of accounting for breast density in the BreastCheck programme.

Commenting on the publication of the protocol, HIQA’s Deputy Chief Executive and Director of Health Technology Assessment, Dr Máirín Ryan, said:

“Screening is an important pillar of public health. Breast cancer screening aims to catch cancer earlier in women who do not have symptoms. This enables earlier treatment, which can reduce mortality.”

“Internationally, there has been growing interest and advocacy in developing screening pathways that take account of breast density. Approaches that have been adopted in some countries include measuring, recording and notifying women of their breast density, and in some cases offering additional imaging. Our assessment will review the available international evidence to help inform a recommendation by the National Screening Advisory Committee to the Minister for Health.”

The protocol for this assessment is now available here.