Abstract
BackgroundBreast cancer is the top cancer by incidence and mortality in Singaporean women. Mammography is by far its best screening tool, but current recommended age and interval may not yield the most benefit. Recent studies have demonstrated the potential of single nucleotide polymorphisms (SNPs) to improve discriminatory accuracy of breast cancer risk assessment models. This study was conducted to understand Singaporean women’s views towards breast cancer screening and SNPs gene testing to guide personalised screening strategies.MethodsFocus group discussions were conducted among English-speaking women (n = 27) between 40 to 65 years old, both current and lapsed mammogram users. Women were divided into four groups based on age and mammogram usage. Discussions about breast cancer and screening experience, as well as perception and attitude towards SNPs gene testing were conducted by an experienced moderator. Women were also asked for factors that will influence their uptake of the test. Transcripts were analysed using thematic analysis to captured similarities and differences in views expressed.ResultsBarriers to repeat mammogram attendance include laziness to make appointment and painful and uncomfortable screening process. However, the underlying reason may be low perceived susceptibility to breast cancer. Facilitators to repeat mammogram attendance include ease of making appointment and timely reminders. Women were generally receptive towards SNPs gene testing, but required information on accuracy, cost, invasiveness, and side effects before they decide whether to go for it. Other factors include waiting time for results and frequency interval. On average, women gave a rating of 7.5 (range 5 to 10) when asked how likely they will go for the test.ConclusionAddressing concerns such as pain and discomfort during mammogram, providing timely reminders and debunking breast cancer myths can help to improve screening uptake. Women demonstrated a spectrum of responses towards a novel test like SNPs gene testing, but need more information to make an informed decision. Future public health education on predictive genetic testing should adequately address both benefits and risks. Findings from this study is used to inform a discrete choice experiment to empirically quantify women preferences and willingness-to-pay for SNPs gene testing.
Highlights
Breast cancer is the top cancer by incidence and mortality in Singaporean women
Likelihood of going for single nucleotide polymorphisms (SNPs) gene testing Women were asked, on a scale of 1 to 10, how likely they will go for the test, given that it is reasonably accurate, can be performed using buccal swab or finger prick and the cost is within the range that they are willing to pay
Our study has found that providing timely reminders to screeningage women will encourage them to turn up for screening
Summary
Breast cancer is the top cancer by incidence and mortality in Singaporean women. Mammography is by far its best screening tool, but current recommended age and interval may not yield the most benefit. This study was conducted to understand Singaporean women’s views towards breast cancer screening and SNPs gene testing to guide personalised screening strategies. Mammography is considered the best screening tool for breast cancer currently and has been associated with reduction in breast cancer deaths [2]. In Singapore, average-risk and asymptomatic women between the age of 50 to 69 are recommended to go for mammogram every two years (Grade A, Level 1++) [3]. Under the national breast cancer screening programme (BreastScreen Singapore [BSS]) launched in 2002, eligible women can receive subsidised screening mammograms at governmentfunded polyclinics or approved private centres. The Singapore Government has extended the use of Medisave, a compulsory medical savings scheme, to offset the cost of screening mammograms since July 2011 [4]
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