Linda Rainey, Mireille Broeders, Daniëlle van der Waal, and colleagues published three papers last month on the future implementation of risk-based breast cancer screening and prevention.Increased knowledge of breast cancer risk factors provides an opportunity to shift from one-size-fits-all screening to a personalised approach, establishing screening and prevention policy based on women’s individual risk of developing breast cancer. Potential implementation of this new paradigm is likely to present considerable challenges, and requires the support from eligible women to facilitate uptake.
Our systematic review of women’s perceptions showed that women carefully review their perceived susceptibility to breast cancer when considering the adoption of this novel screening and prevention programme. Their decisions about participation are based on a cost-benefit analysis of adopting tailored screening, risk-reducing medication, lifestyle changes, and/or prophylactic surgery, whilst taking into account their own perceived competence, autonomy, relatedness to others, and personal preference.
To obtain further insights on acceptability, we performed a mixed-methods study with healthcare professionals from the Netherlands, Sweden, and the United Kingdom who identified five themes that could impact women’s decision-making: (1) Anxiety/worry, (2) Proactive approach, (3) Reassurance, (4) Lack of knowledge, and (5) Organisation of risk assessment and feedback. Dutch and British professionals specifically expressed concerns about the acceptability of a heterogeneous screening policy, suggesting women will question their risk feedback and assigned pathway of care. Swedish professionals emphasised the potential impact on family relations.
Our review of future organisational implications of introducing risk-based breast cancer screening and prevention shows that significant changes in policy and practice are warranted. Feasibility of implementation depends on how healthcare is funded and arranged, and potentially varies between countries. Pilot studies of risk assessment and prevention counselling in primary care settings have highlighted a need for extensive additional training on risk (communication) and prevention, the impact on workflow, and professionals' personal discomfort breaching the topic with women. Additionally, gaps in risk estimation, psychological, ethical and legal consequences will need to be addressed.
Women's perceptions of the adoption of personalised risk-based breast cancer screening and primary prevention: a systematic review.
Rainey L, van der Waal D, Wengström Y, Jervaeus A, Broeders MJM.
Women's decision-making regarding risk-stratified breast cancer screening and prevention from the perspective of international healthcare professionals.
Rainey L, van der Waal D, Donnelly LS, Evans DG, Wengström Y, Broeders M.
Are we ready for the challenge of implementing risk-based breast cancer screening and primary prevention?
Rainey L, van der Waal D, Jervaeus A, Wengström Y, Evans DG, Donnelly LS, Broeders MJM.
Linda Rainey, Mireille Broeders, and Daniëlle van der Waal are all members of theme Women’s cancers.
Related news items
Regional hospitals invest in joint research Four new projects have been granted29 October 2020
Four more research projects have been granted in the promotion fund of the Radboudumc and the regional hospitals.read more
Cum Laude PhD defense for Vincent Aengevaeren29 October 2020
We congratulate Vincent Aengevaeren! After defending his thesis entitled: ‘Potential Detrimental Effects of Exercise on the Heart’ on 28 October, Vincent attained his PhD degree with honors. Vincent had been appointed on a RIHS Junior Researcher grant.read more
Radboudumc research into the effects of COVID-19 measures on migrant workers22 October 2020
Within the Radboud University Network on Migrant Inclusion (RUNOMI), the Radboudumc researches the position and vulnerability of labour migrants within the (Dutch) labor market during the COVID-19 pandemic.read more
Largest study ever on research integrity Aimed at all researchers in the Netherlands15 October 2020
Radboudumc participates in the National Survey on Research Integrity (NSRI), which is being distributed to nearly 40,000 researchers in the Netherlands starting today. Hereby a gentle reminder to complete the survey!read more
Online care concept Luchtbrug improves monitoring and supervision of children with asthma14 October 2020
The online care concept Luchtbrug, an initiative of Radboudumc, is an effective way to monitor and supervise children with asthma. Following the use of Luchtbrug, children need to visit the hospital less often.read more