Personalised risk-based breast cancer screening and primary prevention

5 July 2018

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.

Publications
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.