Women's Views on Multifactorial Breast Cancer Risk Assessment and Risk-Stratified Screening: A Population-Based Survey from Four Provinces in Canada.

Cynthia Mbuya Bienge,Palmira Granados Moreno,Michael Wolfson,Laurence Lambert-Côté,Emmanuelle Lévesque,Jocelyne Chiquette,Nora Pashayan,Julie Lapointe,Michel Dorval,Julie Hagan,Yann Joly,Laurence Eloy,Hermann Nabi,Jacques Simard,Annie Turgeon,Jennifer Brooks,Gratien Dalpé,Kristina M Blackmore ,Jean‐Sébastien Paquette ,Anna M Chiarelli ,Bartha Maria Knoppers ,Mark Walker ,Mireille J M Broeders

doi:10.3390/jpm11020095

Abstract

Risk-stratified screening for breast cancer (BC) is increasingly considered as a promising approach. However, its implementation is challenging and needs to be acceptable to women. We examined Canadian women’s attitudes towards, comfort level about, and willingness to take part in BC risk-stratified screening. We conducted an online survey in women aged 30 to 69 years in four Canadian provinces. In total, 4293 women completed the questionnaire (response rate of 63%). The majority of women (63.5% to 72.8%) expressed favorable attitudes towards BC risk-stratified screening. Most women reported that they would be comfortable providing personal and genetic information for BC risk assessment (61.5% to 67.4%) and showed a willingness to have their BC risk assessed if offered (74.8%). Most women (85.9%) would also accept an increase in screening frequency if they were at higher risk, but fewer (49.3%) would accept a reduction in screening frequency if they were at lower risk. There were few differences by province; however, outcomes varied by age, education level, marital status, income, perceived risk, history of BC, prior mammography, and history of genetic test for BC (all p ≤ 0.01). Risk-based BC screening using multifactorial risk assessment appears to be acceptable to most women. This suggests that the implementation of this approach is likely to be well-supported by Canadian women.

Highlights

The Canadian Task Force on Preventive Health Care recommends that women aged50–74 be screened with mammography every 2 to 3 years [1]
Several participants’ characteristics were significantly associated with their views on risk-stratified screening
The present study provides evidence suggesting that the implementation of riskstratified breast cancer (BC) screening is likely to be well-supported by Canadian women

Summary

Introduction

The Canadian Task Force on Preventive Health Care recommends that women aged50–74 be screened with mammography every 2 to 3 years [1]. Risk-stratified BC screening, in which individual risk assessment based on multiple risk factors is used to tailor screening recommendations (e.g., more screening for women at higher risk and less screening for those at lower risk), has been proposed as an alternative to the current age-based approach [5,6,7]. Simulation models have shown this approach has the potential to increase the detection of breast cancers while decreasing false-positive outcomes and overdiagnosis, thereby overcoming the main limitations of today’s age-based screening programs [5,8]. Burgeoning evidence from studies conducted in the United Kingdom (UK), Sweden, Netherlands, and Australia [12,13,14,15,16,17,18] indicates that women appear to welcome the prospect of risk-stratified BC screening

Methods

Results

Discussion

Conclusion