“Mammograms are kind of my pacifier”: The cultural context of women's preference for annual mammograms in a risk-based screening cohort

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Population genetic testing and risk-based screening have the potential to shift how we determine risk and screen for breast cancer. While much attention has been paid to the experiences of individuals who may be at elevated risk for breast cancer, less is known about how those at average risk make decisions about their health. Through qualitative interviews with 30 participants, we explore how those enrolled in a risk-based screening trial who are determined to be at average risk for breast cancer make screening decisions. We consider how the social context of breast health, known as ‘pink ribbon culture,’ and the pervasiveness of annual mammography as the standard of care make risk-based screening less acceptable for many participants. Risk-based screening paradigms assume that individuals will assess their risk quantitatively based on the risk models that are used. Yet, our findings demonstrate that social and cultural factors influence decision-making surrounding breast cancer screening, an important consideration when implementing risk-based screening programs. We will begin to address a gap in knowledge about how women who are told they are average risk after risk-based screening (most of the population) and recommended to screen less than annually make screening decisions.