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Trial Title: Risk-Based Breast Screening in Young Women

NCT ID: NCT05675085

Condition: Breast Neoplasms

Conditions: Official terms:
Breast Neoplasms

Conditions: Keywords:
Breast Neoplasms
Cancer Screening
Personalized Medicine
Mammographic Breast Density
Risk Assessment

Study type: Interventional

Study phase: N/A

Overall status: Active, not recruiting

Study design:

Allocation: N/A

Intervention model: Single Group Assignment

Primary purpose: Screening

Masking: None (Open Label)

Intervention:

Intervention type: Diagnostic Test
Intervention name: Personalized screening protocol
Description: At the first screening round (recruitment) all participating women had the same tests; - Two-view tomosynthesis of both breasts - Calculation of volumetric breast density (VBD) - Calculation of lifetime risk (LTR) using the Tyrer-Cuzick model At subsequent rounds: 1. Women with non-dense breasts and low breast cancer risk are re-screened only with DBT every 2 years; 2. Women with dense breasts and low breast cancer risk are re-screened with DBT+US every 2 years; 3. Women with non-dense breasts and intermediate breast cancer risk are re-screened only with DBT every year; 4. Women with dense breasts and intermediate breast cancer risk are re-screened with DBT+US every year; 5. Women at high risk of breast cancer associated with a family history of breast cancer (w/wo hereditary factors) undergo DBT and MRI every year.
Arm group label: RIBBS arm

Summary: The RIBBS study is a single-arm single-center study that aims to evaluate the effectiveness of a risk-based breast screening model using digital breast tomosynthesis (DBT) as the baseline test, quantitative individual breast density to guide supplemental ultrasound (US) imaging for dense breasts, and individual risk (calculated taking into account breast density) to guide the screening interval (annual or biennial). Invited 45-year-old women are differentiated into five different screening protocols (based on breast density and risk), and screened according to a personalized model until they turn 50 and return to routine screening. The only primary endpoint in this study is the cumulative incidence of advanced breast cancers (stage II and above). This endpoint will be evaluated at the end of the five-year intervention period and at 10 years. The results of the personalized screening model will be compared with those obtained from an observational cohort from a neighboring region in which a "one-size-fits-all" approach involving annual mammography for women aged 45-49 years is used. The comparison will be conducted with the hypothesis of superiority of the personalized screening model.

Detailed description: The incidence of breast cancer in women aged 45 to 49 is not much lower than in women aged 50 to 54. However, while the Italian Health System offers mammography screening to all women aged 50 to 69 every two years, women aged 45 to 49 are invited for annual mammography screening in only a few regions. Breast density, i.e. the amount of fibroglandular tissue, more present in young women, decreases the performance of mammography by reducing the detectability of breast cancer; consequently, breast cancer in women with dense breasts can often be found only when it is larger and thus at a more advanced stage. In addition, breast density is an independent risk for breast cancer. The RIBBS study was designed to use the first round of screening to identify women with dense breasts and those at increased risk of breast cancer, and use this information to tailor the subsequent screening protocol, including supplemental US imaging for women with dense breasts, and establishing the frequency of screening cycles according to risk category. The reference imaging is digital breast tomosynthesis, which has already demonstrated greater sensitivity than digital mammography in the "standard" screening age (50-69). Volumetric breast density (VBD) is calculated from DBT, and lifetime risk (LTR) is obtained from the Tyrer-Cuzick risk model which also includes breast drnsity as a risk factor. After the first round of screening, women are divided into five groups: women with non-dense breasts and low breast cancer risk are screened every two years with DBT alone; women with dense breasts and low breast cancer risk are screened every two years with DBT plus additional ultrasound (DBT+US); women with non-dense breasts and intermediate risk of breast cancer are screened annually with DBT alone; women with dense breasts and intermediate risk of breast cancer are screened annually with DBT+US; finally, high-risk women with a family history of breast cancer (w/wo hereditary factors) are monitored with annual MRI and tomosynthesis. Our study hypothesizes that a screening model stratified by breast density and risk is more effective and sustainable in reducing the incidence of advanced breast cancer than standard annual mammography screening.

Criteria for eligibility:
Criteria:
Inclusion Criteria: - Female - Aged 45 years old - Resident in the provinces of Padua and Rovigo (Italy) - Willing and able to give written informed consent - Willing and able to comply with scheduled visits, tests, and other procedures Exclusion Criteria: - Recent mammography - Personal history of breast carcinoma, either invasive or ductal carcinoma in situ (DCIS) - Known BRCA carrier or PALB2 or ≥50% risk - Psychiatric or other disorders that are not compatible with compliance to the protocol requirements and follow-up - Pregnant or breastfeeding - Unable to give informed consent - Current participation in another interventional breast screening trial

Gender: Female

Gender based: Yes

Minimum age: 45 Years

Maximum age: 45 Years

Healthy volunteers: Accepts Healthy Volunteers

Locations:

Facility:
Name: Istituto Oncologico Veneto (IRCCS)

Address:
City: Padova
Zip: 35128
Country: Italy

Start date: January 20, 2020

Completion date: January 31, 2026

Lead sponsor:
Agency: Istituto Oncologico Veneto IRCCS
Agency class: Other

Collaborator:
Agency: Regione del Veneto (Italy)
Agency class: Other

Source: Istituto Oncologico Veneto IRCCS

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT05675085

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