Barriers and Facilitators to the Implementation of a Personalized Breast Cancer Screening Program: Views of Spanish Health Professionals.

Celmira Laza-Vásquez,Maria José Pérez-Lacasta,Montserrat Rué,Misericòrdia Carles-Lavila,María José Hernández-Leal,Inés Cruz-Esteve

doi:10.3390/ijerph19031406

Abstract

This study explored the barriers and facilitators to the implementation of a risk-based breast cancer screening program from the point of view of Spanish health professionals. A cross-sectional study with 220 Spanish health professionals was designed. Data were collected in 2020 via a web-based survey and included the advantages and disadvantages of risk-based screening and barriers and facilitators for the implementation of the program. Descriptive statistics and Likert scale responses analyzed as category-ordered data were obtained. The risk-based screening was considered important or very important to reduce breast cancer mortality and promote a more proactive role for women in breast cancer prevention, to increase coverage for women under 50 years, to promote a breast cancer prevention strategy for women at high risk, and to increase efficiency and effectiveness. Switching to a risk-based program from an age-based program was rated as important or very important by 85% of participants. As barriers for implementation, risk communication, the workload of health professionals, and limited human and financial resources were mentioned. Despite the barriers, there is good acceptance, and it seems feasible, from the perspective of health professionals, to implement a risk-based breast cancer screening program in Spain. However, this poses a number of organizational and resource challenges.

Highlights

Introduction iationsSystematic reviews of clinical trials assessing the effectiveness of mammographic screening for early diagnosis of breast cancer show a reduction in breast cancer mortality of approximately 20% [1,2,3]
This study explored the barriers and facilitators to implementing a risk-based breast cancer screening program from the point of view of health professionals, in the context of the Spanish National Health Service
Of the 220 health professionals that participated in the study, 3 out of 4 were women

Summary

Introduction

Systematic reviews of clinical trials assessing the effectiveness of mammographic screening for early diagnosis of breast cancer show a reduction in breast cancer mortality of approximately 20% [1,2,3]. Mammographic screening is associated with harms such as overdiagnosis, false-positive biopsy findings, or false-negative results that may delay the diagnosis due to false reassurance. Moving from the current one-size-fits-all screening policy to personalized risk-based screening approaches can potentially optimize the harm-benefit ratio, by targeting screening to women who will get the greatest benefit while reducing complications among women who would experience little benefit [4,5]. The personalized screening will probably be the standard for early detection in the near future. Healthcare systems face the challenge of transforming current screening programs to improve their quality and efficiency and contribute to their sustainability.

Methods

Results

Conclusion