Abstract
Simple SummaryRisk-based breast screening will involve tailoring the amount of screening to women’s level of risk. Therefore, women at high-risk may be offered more frequent screening and over a longer period of time than those at low risk for whom less screening may be recommended. As this will involve considerable changes to the NHS Breast Screening Programme, it is important to explore what women in the UK think and feel about this approach. Analysis of in-depth interviews revealed that some women would find both high and low-risk screening options acceptable whereas others were resistant to the prospect of reduced screening if they were assessed as low-risk. We also found that the idea of risk-based screening had little influence on the attitudes of women who were already sceptical about breast screening. These findings highlight the communication challenges that will be faced by those introducing risk-based screening and suggest a need for tailored support and advice.Any introduction of risk-stratification within the NHS Breast Screening Programme needs to be considered acceptable by women. We conducted interviews to explore women’s attitudes to personalised risk assessment and risk-stratified breast screening. Twenty-five UK women were purposively sampled by screening experience and socioeconomic background. Interview transcripts were qualitatively analysed using Framework Analysis. Women expressed positive intentions for personal risk assessment and willingness to receive risk feedback to provide reassurance and certainty. Women responded to risk-stratified screening scenarios in three ways: ‘Overall acceptors’ considered both high- and low-risk options acceptable as a reasonable allocation of resources to clinical need, yet acceptability was subject to specified conditions including accuracy of risk estimates and availability of support throughout the screening pathway. Others who thought ‘more is better’ only supported high-risk scenarios where increased screening was proposed. ‘Screening sceptics’ found low-risk scenarios more aligned to their screening values than high-risk screening options. Consideration of screening recommendations for other risk groups had more influence on women’s responses than screening-related harms. These findings demonstrate high, but not universal, acceptability. Support and guidance, tailored to screening values and preferences, may be required by women at all levels of risk.
Highlights
The UK National Health Service Breast Screening Programme (NHSBSP) currently invites all women aged 50–70 in the UK for triennial mammography
Risk-prediction models have integrated mammographic breast density and polygenic risk scores which have increased their discriminatory efficacy [2,3]. This has led to an increased interest in risk-stratified breast screening (RSBS), i.e., adapting screening recommendations to a woman’s breast cancer risk [4]
As our focus was on women at population-level breast cancer risk, those with a previous and/or current diagnosis of breast cancer were excluded alongside women in receipt of RSBS under NICE guidelines for high familial risk
Summary
The UK National Health Service Breast Screening Programme (NHSBSP) currently invites all women aged 50–70 in the UK for triennial mammography. Risk-prediction models have integrated mammographic breast density and polygenic risk scores which have increased their discriminatory efficacy [2,3]. This has led to an increased interest in risk-stratified breast screening (RSBS), i.e., adapting screening recommendations to a woman’s breast cancer risk [4]. Simulation models suggest this approach has the potential to increase the benefits of screening (via early detection of cancer) while decreasing screening-related harms, e.g., false positive results and overdiagnosis [5,6,7,8]. The screening preferences and values of prospective service users and their willingness to engage with this screening approach are of key importance
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