ASSURE - Adapting Breast Cancer Screening Strategy Using Personalised Risk Estimation - consists of 10 project partners from 7 countries with leading expertise in the field of breast imaging, with the Radboud University Nijmegen Medical Centre as the coordinating partner. The project started in December 2012 and is supported by the European Commission under the 7th Framework Programme for Health Research.

Approximately 1 in 8 women develop breast cancer during their lifetime. Screening programs have been introduced, decreasing the mortality rate and allowing for less radical treatment options for early detected cancers. Unfortunately not all cancers are detected in screening. Approximately 30% of breast cancers are detected between screening rounds. This constitutes a need for improved cancer screening.

The ASSURE project promotes going from a one-size-fits-all approach to a personalised screening protocol. Nowadays all women undergo the same screening protocol, independent of the density of their breast tissue and the risk to develop breast cancer. Almost all women make use of the same diagnostic modality, X-ray mammography.

Unfortunately the sensitivity of mammographic screening is seriously impaired in woman with dense breasts. Fibroglandular and stromal tissue look equally bright as tumours on mammographic images. This causes tumours to remain masked for radiologists and thus breast cancer to remain undetected.

Examples of breast density patterns, with overall density increasing from left to right.

One task of the project is to estimate personal risk depending on breast density, age, gene mutations, family and/or personal history, etc., and based on this risk, propose an optimal, cost effective, personalized screening strategy. 
Secondly research will be done on improving the use of MRI and Automatic Breast UltraSound (ABUS) as additional breast cancer screening modalities, by optimizing protocols, improving reading workflow, and by offering better diagnostic performance, through software solutions.

Expected Results & Impact

Effective breast cancer screening substantially reduces mortality and maintains the quality of life of women. Additionally, less disfiguring treatments are required. A new stratification protocol and new screening tools will result from this project. The screening process will be optimised in response to the increased awareness regarding the low sensitivity of current breast cancer screening in women with dense breasts. Our estimations show that a reduction of interval cancers of at least 30% is achievable, assuming the efforts in this project lead to a sensitivity for dense breast comparable to that of non-dense breasts. Furthermore, the risk stratification enabled by this project will benefit the low risk group (10-15% of women) as their screening interval can be further optimized (and increased) to limit the adverse effects due to the radiation inherent with X-ray mammography screening.

The ASSURE project will be an excellent opportunity for the participating SMEs (small and medium-sized enterprises), which each is a recognized innovator in its market segment, to join forces with leading research institutions and national screening experts. This joint effort will allow the ASSURE consortium to excel at demonstrating their combined technologies and future products have the potential to substantially improve breast cancer screening in Europe. 

Exploitable results from this project are expected to include (1) new and validated measures for breast density (Mātakina and Biomediq), (2) a quality assurance system for breast cancer screening with ABUS and MRI (Mediri), (3) new sequences for breast cancer screening with MRI (Mediri) and (4) dedicated screening software for high-throughput ABUS and MRI reading (MeVis Medical Solutions).