Abstract
BackgroundUK national guidelines suggest women at high-risk of breast cancer should be offered more frequent screening or preventative medications. Currently, only 1 in 6 high-risk women are identified. One route to identify more high-risk women is via multifactorial risk assessment as part of the UK’s NHS Breast Screening Programme (NHSBSP). As lower socioeconomic and minority ethnic populations continue to experience barriers to screening, it is important that any new service does not exacerbate issues further. To inform service development, this study explored views of women from underserved backgrounds regarding the introduction of risk stratification into the NHSBSP.MethodsNineteen semi-structured interviews were conducted with British-Pakistani women from low socioeconomic backgrounds from East Lancashire, UK. Fourteen interviews were conducted via an interpreter.ResultsThematic analysis produced three themes. Attitudes toward risk awareness concerns the positive views women have toward the idea of receiving personalised breast cancer risk information. Anticipated barriers to accessibility emphasises the difficulties associated with women’s limited English skills for accessing information, and their I.T proficiency for completing an online risk assessment questionnaire. Acceptability of risk communication strategy highlights the diversity of opinion regarding the suitability of receiving risk results via letter, with the option for support from a healthcare professional deemed essential.ConclusionsThe idea of risk stratification was favourable amongst this underserved community. To avoid exacerbating inequities, this new service should provide information in multiple languages and modalities and offer women the opportunity to speak to a healthcare professional about risk. This service should also enable completion of personal risk information via paper questionnaires, as well as online.
Highlights
UK national guidelines suggest women at high-risk of breast cancer should be offered more frequent screening or preventative medications
Views from British-Pakistani women regarding the introduction of risk stratified screening into the NHS Breast Screening Programme (NHSBSP) were grouped into three themes: (1) Attitudes toward risk awareness, (2) Anticipated barriers to accessibility, and (3) Acceptability of risk communication strategy
Women explained that risk information is important for healthcare professionals to share and introducing this service into the NHSBSP would be a good idea in order to raise awareness: Yes, you should do, should give out this
Summary
UK national guidelines suggest women at high-risk of breast cancer should be offered more frequent screening or preventative medications. In 2013 the UK National Institute of Health and Care Excellence (NICE) Clinical Guidelines for familial breast cancer suggested that breast screening should be stratified, with high-risk women (defined as having a ≥ 30% chance of developing breast cancer in their lifetimes or a ≥ 8% 10-year risk) being offered the opportunity for more frequent screening or chemoprevention medication [1]. To fully implement NICE guidelines [1], risk estimation and stratified screening will need to be embedded into routine breast screening programmes to enable all women at high or aboveaverage (moderate) risk to benefit from preventative services. BC-Predict is utilising the Tyrer-Cuzick model of risk estimation [7], incorporating mammographic breast density and, in a subsample of participants, SNPs
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