Acceptability of risk‐stratified population screening across cancer types: Qualitative interviews with the Australian public

Kate Dunlop,Ainsley J Newson,Louise Keogh,Anne E Cust,Amelia K Smit,Zofia Salgado,Nicole M Rankin

doi:10.1111/hex.13267

Abstract

BackgroundThere is mounting evidence of the benefit of risk‐stratified (risk‐tailored) cancer population screening, when compared to standard approaches. However, shifting towards this approach involves changes to practice that may give rise to implementation challenges.ObjectivesTo explore the public's potential acceptance of risk‐stratified screening across different cancer types, including reducing screening frequency if at low risk and the use of personal risk information, to inform implementation strategies.MethodSemi‐structured interviews were conducted with 40 public participants; half had received personal genomic risk information and half had not. Participants were prompted to consider different cancers. Data were analysed thematically as one dataset.ResultsThemes included the following: (a) a sense of security; (b) tailored screening is common sense; (c) risk and the need to take action; (d) not every cancer is the same; and (e) trust and belief in health messages. Both groups expressed similar views. Participants were broadly supportive of risk‐stratified screening across different cancer types, with strong support for increased screening frequency for high‐risk groups. They were less supportive of reduced screening frequency or no screening for low‐risk groups. Findings suggest the public will be amenable to reducing screening when the test is invasive and uncomfortable; be less opposed to forgo screening if offered the opportunity to screen at some stage; and view visible cancers such as melanoma differently.ConclusionsApproaching distinct cancer types differently, tailoring messages for different audiences and understanding reasons for participating in screening may assist with designing future implementation strategies for risk‐stratified cancer screening.

Highlights

There is mounting evidence of the benefit of risk-stratified cancer population screening, when compared to standard approaches
Approaching distinct cancer types differently, tailoring messages for different audiences and understanding reasons for participating in screening may assist with designing future implementation strategies for risk-stratified cancer screening
To add to the evidence from modelling studies, several large trials are more definitively assessing the relative benefits and harms of risk-stratified screening.4-9 Successful implementation of tailored screening approaches will depend on it being accepted by end-users, such as the general public.10-12 Acceptability in this setting refers to the perception that the use of additional risk factors and tailored screening advice is agreeable 13 and in the target population's interest[11]; increasing the likelihood that individuals will adhere to recommendations and benefit from improved clinical outcomes.[14]

Summary

Introduction

There is mounting evidence of the benefit of risk-stratified (risk-tailored) cancer population screening, when compared to standard approaches. In comparison with the mostly ‘one size fits all’ approaches used in existing population screening for cancer, there is mounting evidence that risk-stratified (risk-tailored) screening can both improve the early detection of cancer for those most likely to benefit and reduce the well-recognized harms of screening for those at lower risk.1-4 Stratification of individuals into risk groups may be based on assessment of factors such as personal genomic and/or lifestyle risk information, as well as traditional risk factors such as age, family history or ethnicity. Shifting towards a risk-stratified screening approach will involve changes to current practice, including recommending more frequent screening for those at high-risk, different modalities of screening, and modified start and stop times These changes may present challenges for implementation, for example the use of personal risk information to inform screening advice and a move towards less screening or potentially no screening for those at low risk. Opportunistic screening is available for skin cancer[21] and prostate cancer.[22]

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