Abstract
BackgroundThere is international interest in risk-stratification of breast screening programmes to allow women at higher risk to benefit from more frequent screening and chemoprevention. Risk-stratification also identifies women at low-risk who could be screened less frequently, as the harms of breast screening may outweigh benefits for this group. The present research aimed to elicit the views of national healthcare policy decision-makers regarding implementation of less frequent screening intervals for women at low-risk.MethodsSeventeen professionals were purposively recruited to ensure relevant professional group representation directly or indirectly associated with the UK National Screening Committee and National Institute for Health and Care Excellence (NICE) clinical guidelines. Interviews were analysed using thematic analysis.ResultsThree themes are reported: (1) producing the evidence defining low-risk, describing requirements preceding implementation; (2) the impact of risk stratification on women is complicated, focusing on gaining acceptability from women; and (3) practically implementing a low-risk pathway, where feasibility questions are highlighted.ConclusionsOverall, national healthcare policy decision-makers appear to believe that risk-stratified breast screening is acceptable, in principle. It will however be essential to address key obstacles prior to implementation in national programmes.
Highlights
There is international interest in risk-stratification of breast screening programmes to allow women at higher risk to benefit from more frequent screening and chemoprevention
The National Health Service Breast Screening Programme (NHSBSP) currently invites women aged 50–70 years registered with a general practitioner (GP) in the United Kingdom to attend for 3-yearly mammograms
Lists were obtained for the UK National Screening Committee (UKNSC), UKNSC Adult Reference Group, Advisory Committee on Breast Cancer Screening as well as the National Institute for Health and Care Excellence (NICE) Committees and Guideline writing groups
Summary
There is international interest in risk-stratification of breast screening programmes to allow women at higher risk to benefit from more frequent screening and chemoprevention. Risk-stratification identifies women at low-risk who could be screened less frequently, as the harms of breast screening may outweigh benefits for this group. There has been considerable debate around the harms and benefits of breast screening [5] This has primarily centered on overdiagnosis i.e. women who receive treatment for malignancies that would have never presented symptomatically without screening [6], and false positive test results [7]. It is recommended that women at high-risk of breast cancer are offered more frequent screening or chemoprevention [8]. There is no systematic process for identifying either group in routine screening
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