MyScreen Trial: Risk-adjusted breast cancer screening

The challenge:

Currently, 51% of breast cancers in Australia are diagnosed at Stage 2 or later. Finding these cancers earlier is critical. BreastScreen Australia (BSA) offers mammographic screening every two years, targeted to women aged 50–74. Women aged 40–49 are eligible to attend, but they are not actively invited because the balance of benefits and potential harms of routine screening are less clear in this younger age group. More than half of all women in the target age group attend breast screening every two years. Interval cancers (cancers found between screenings) represent around 23% of breast cancer diagnoses in the BSA-screened population.

Breast screening could be improved by tailoring it to a woman’s individual risk. Higher breast density (the proportion of dense glandular tissue compared to fatty tissue in the breast) is linked to an increased risk of breast cancer and makes tumours harder to see on standard mammograms. Some state BreastScreen programs now notify women about their breast density, and while there is guidance for GPs on what should be offered to women with high breast density, there are no national guidelines.

While international trials of more personalised breast screening are underway, their findings cannot be directly applied in Australia due to differences in health systems, funding arrangements and population characteristics. Major changes to policy and practice in Australia require the development and testing of risk-adjusted screening that is tailored to the Australian public screening context.

Project description:

In this NBCF-funded project, Associate Professor Carolyn Nickson and team from the Cancer Elimination Collaboration at the University of Sydney will commence the MyScreen Trial, in collaboration with BreastScreen Victoria, the Royal Melbourne Hospital (RMH) , Breast Cancer Trials and the Breast Cancer Network of Australia. This pilot study will test a more personalised risk-based approach to breast screening, where women at higher risk are offered additional screening that may improve the chance of detecting breast cancers at an earlier stage. The trial is codesigned by clinical, research and consumer partners to ensure it is practical, acceptable to women and aligned with public screening services.

The MyScreen Trial will recruit 750 BreastScreen Victoria clients who are identified as higher risk based on a combination of factors such as breast density and family history. They will be offered no-cost supplemental imaging through RMH, either MRI or Contrast Enhanced Mammography, alongside routine BreastScreen care. The study will include participants aged 40–49 to better understand the potential of risk-based screening for this younger group.

The MyScreen Trial will track cancer detection rates, interval cancer rates, false positives (tests that suggest cancer when there is none), supplemental screening participation, and the experiences of women invited to have additional screening. This information will be used to assess whether a risk‑based approach to supplemental screening is feasible to deliver, acceptable to women and clinics, clinically effective, and cost-effective compared with the current screening program. The findings will inform the design of a future large-scale Australian trial of risk-based breast screening.

Potential impact:

By adjusting screening to individual risk, the MyScreen Trial aims to improve early detection for those most likely to benefit. Results from this pilot study will provide real‑world Australian evidence to guide future decisions about breast screening, including clearer guidance for women with higher breast density. In the longer term, a risk‑based approach could support more equitable access to effective screening and help ensure that public resources are used where they make the biggest difference for people affected by breast cancer.

Grant code: 2025/RPG0065
Active years: 2026-2030
Scientific project title: The MyScreen Project: Risk-Adjusted Population Breast Cancer Screening Through the BreastScreen Program