Abstract
BackgroundRisk-based breast cancer screening may improve the benefit-harm ratio of screening by tailoring policy to a woman’s personal breast cancer risk. This study aims to explore Dutch women’s preferences regarding the organisation and implementation of a risk-based breast cancer screening and prevention programme, identifying potential barriers and facilitators to uptake.MethodsA total of 5110 participants in the Dutch Personalised RISk-based MAmmography screening (PRISMA) study were invited, of whom 942 completed a two-part web-based survey. The first part contained questions about personal characteristics; for the second part, women were randomly assigned to one of four hypothetical breast cancer risk scenarios (i.e. low, average, moderate, or high) with subsequent tailored screening and prevention advice. Descriptive statistics are used to present women’s organisational preferences. Univariable and multivariable logistic regression analyses were performed using seven proxy measures for acceptability of risk-based screening (e.g., interest in risk) and risk-based prevention (e.g., willingness to change diet).ResultsInterest in breast cancer risk was high (80.3%). Higher assigned risk scenario was most consistently associated with acceptance of tailored screening and prevention recommendations. Increased acceptance of lifestyle changes was additionally associated with higher education. Having a first degree family history of breast cancer decreased women’s motivation to participate in preventative lifestyle measures. Acceptability of medication was associated with a woman’s general beliefs about the (over)use and benefit-harm balance of medication.ConclusionsDutch women generally appear in favour of receiving their breast cancer risk estimate with subsequent tailored screening and prevention recommendations. However, women’s level of acceptance depends on their assigned risk category. Offering tailored screening and prevention recommendations to low-risk women will be most challenging. Educating women on the benefits and harms of all risk-based screening and prevention strategies is key to acceptability and informed decision-making.
Highlights
Risk-based breast cancer screening may improve the benefit-harm ratio of screening by tailoring policy to a woman’s personal breast cancer risk
Women in the United Kingdom have expressed high interest in knowing their breast cancer risk [5, 6]. It is unclear whether Dutch women are open to having their breast cancer risk assessed and participating in tailored screening strategies based on this personal breast cancer risk
The Personalised RISkbased MAmmography screening (PRISMA) study is a large prospective cohort study which is currently being performed in the setting of the Dutch national screening programme
Summary
Risk-based breast cancer screening may improve the benefit-harm ratio of screening by tailoring policy to a woman’s personal breast cancer risk [1, 2]. Subsequent risk-tailored screening policy could potentially correspond more closely to a woman’s individual preferences Informing women about their breast cancer risk provides opportunities to educate them on breast cancer prevention [3], providing tailored advice on healthy lifestyle behaviours and riskreducing medication. Women in the United Kingdom have expressed high interest in knowing their breast cancer risk [5, 6] It is unclear whether Dutch women are open to having their breast cancer risk assessed and participating in tailored screening strategies based on this personal breast cancer risk. Women in the Netherlands have been informed that the benefits of biennial mammography screening outweigh the harms and any changes might be met with scepticism
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