Personalized early detection and prevention of breast cancer: ENVISION consensus statement

Abstract: The European Collaborative on Personalized Early Detection and Prevention of Breast Cancer (ENVISION) brings together several international research consortia working on different aspects of the personalized early detection and prevention of breast cancer. In a consensus conference held in 2019, the members of this network identified research areas requiring development to enable evidence-based personalized interventions that might improve the benefits and reduce the harms of existing breast cancer screening and prevention programmes. The priority areas identified were: 1) breast cancer subtype-specific risk assessment tools applicable to women of all ancestries; 2) intermediate surrogate markers of response to preventive measures; 3) novel non-surgical preventive measures to reduce the incidence of breast cancer of poor prognosis; and 4) hybrid effectiveness–implementation research combined with modelling studies to evaluate the long-term population outcomes of risk-based early detection strategies. The implementation of such programmes would require health-care systems to be open to learning and adapting, the engagement of a diverse range of stakeholders and tailoring to societal norms and values, while also addressing the ethical and legal issues. In this Consensus Statement, we discuss the current state of breast cancer risk prediction, risk-stratified prevention and early detection strategies, and their implementation. Throughout, we highlight priorities for advancing each of these areas

Breast Cancer

Breast cancer is the most common cancer in young women. Fortunately, the survival rates are very high, especially in the early stages. Chemotherapy can lead to amenorrhea and infertility, especially in women >30 years of age. The most common chemotherapies impose a significant risk of premature ovarian insufficiency, especially in women >30 years of age. In these women GnRH agonists, freezing of oocytes and freezing of ovarian tissue alone or in combination are options to preserve fertility. If ovarian stimulation is chosen, aromatase inhibitors should be added in estrogen-sensitive cancer to reduce estrogen blood concentrations