The Health Information and Quality Authority (HIQA) has 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.

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. 

Breast density refers to the proportion of fibroglandular (dense) tissue relative to adipose (fatty) tissue in the breast. Women with dense breasts have an increased risk of developing breast cancer compared with those with non-dense breasts. 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 at the bottom of this page. 

ENDS

Notes for Editor: 

• The National Screening Advisory Committee (NSAC) was established by the Minister for Health as an independent advisory committee to play a significant strategic role in developing and considering population-based screening programmes in Ireland. 

• At the request of the Department of Health, the Health Technology Assessment (HTA) Directorate within the Health Information and Quality Authority (HIQA) undertakes evidence synthesis and provides evidence-based advice to NSAC on behalf of the Minister for Health.

• This assessment is being carried out as part of a larger piece of work that will also evaluate potential age extensions to the BreastCheck programme. A separate protocol will outline the approach to the assessment of extending BreastCheck to women aged 45 to 49 years and 70 to 74 years. 

• The strongest risk factors for breast cancer are female sex and increasing age. Other risk factors include hormonal and reproductive factors, breast density, hereditary and genetic factors, body mass index (BMI), alcohol consumption, and environmental exposures.

• Breast density can be influenced by age, BMI, genetic factors, ethnicity, age at menarche (when menstrual periods begin), reproductive factors, use of hormone replacement therapy, and alcohol consumption.