Envisioning Implementation of a Personalized Approach in Breast Cancer Screening Programs: Stakeholder Perspectives

Abstract

Background: Advances in genomics and epidemiology can foster the implementation of a riskbased approach to current age-based breast cancer screening programs. This personalized approach would challenge the trajectory for women in the healthcare system by adding both a risk-assessment step (including a genomic test) and screening options. Objective: The aim of this study is to explore, from an organizational perspective, the acceptability of different proposals for each step of the trajectory for women in the healthcare system should a personalized approach be implemented in the province of Quebec. Methods: We interviewed 20 professional stakeholders who are either involved in the current breast cancer screening program in Quebec or who are likely to play a role in the future implementation of a personalized risk-based approach. Results and discussion: Preferences are split between proposals supporting self-management by the women themselves (e.g., solicitation through media campaign, self-collection of information and sample and results provided by letter) and proposals prioritizing more interaction between women and healthcare providers (e.g., solicitation by health professionals, collection of information and samples by a nurse and results provided by health professionals). Résumé Contexte : Les avancées de la science en génomique et en épidémiologie pourraient favoriser l'implantation d' une approche basée sur le risque dans les programmes de dépistage du cancer du sein qui sont actuellement basés sur l'âge. Cette approche personnalisée poserait des défis à la trajectoire des femmes dans le système de santé en ajoutant à la fois une étape d'évaluation du risque (incluant un test génomique) et des options de dépistage. Objectif : L' objectif de cette étude est d' explorer, dans une perspective organisationnelle, l' acceptabilité de différentes propositions pour chaque étape de la trajectoire des femmes dans le système de santé si une telle approche était implantée dans la province de Québec. Méthode : Nous avons mené des interviews auprès de 20 acteurs du milieu de la santé qui sont impliqués dans le programme actuel de dépistage du cancer du sein au Québec ou qui seraient appelés à jouer un rôle advenant l'implantation d' une approche personnalisée basée sur le risque. Résultats et discussion : Les préférences des interviewés sont partagées entre les propositions qui favorisent l' autogestion par les femmes elles-mêmes (p. ex. sollicitation par des campagnes médiatiques, collecte autonome d'information et d'échantillon, résultat transmis par lettre) et les propositions qui favorisent plus d'interactions entre les femmes et les fournisseurs de soins (p. ex. sollicitation par des professionnels de la santé, collecte d'information et d'échantillon par une infirmière et résultat transmis par un professionnel de la santé).

Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours

“…Nursing staff were underrepresented in the included studies. Decision makers have suggested that nurses could assume increased duties in risk assessment and management to support implementation of risk-based screening and prevention [71]. In relation to primary prevention, general practitioners have been found to perceive intervening on obesity as an inappropriate use of their time in comparison to nurses who report feeling responsible for raising the topic [72].…”

Personalized Risk Assessment for Prevention and Early Detection of Breast Cancer: Integration and Implementation (PERSPECTIVE I&I)

“…Building on the results from our previous engagement with decision makers [60][61][62], and our extensive research on genetic discrimination [63] and regulatory approval in personalized healthcare [64], potential options to address emergent socio-ethical and legal challenges associated with the implementation of risk-based screening have been identified. These options are being investigated through interdisciplinary legal, ethical and social analyses described below.…”

“…As the personalized risk-based approach may involve risk estimation for tens of thousands of women each year, we anticipate that specialized medical health professionals (e.g., geneticists, genetic counsellors) may be reserved for the most complex cases. Decision makers have suggested that nurses could assume increased duties [62], including sampling, requesting laboratory analysis, ordering imaging exams, and providing personalized follow-up recommendations to support this approach. Consideration of this approach is critical both to containing costs and avoiding resource constraints (e.g., genetic counsellors).…”

Breast cancer screening program for risk groups: facts and perspectives

“…In the search for efficiency and risk reduction for health service users, ways to institute care centered on their needs and supported by evidence are currently being discussed, including for breast cancer detection programs (10)(11)(12)(13)(14)(15)(16) . Thus, modeling, protocols, tools and feasibility assessments emerged for the implementation of personalized breast cancer prevention and early detection by risk stratification, involving users and other health system actors (5,(10)(11)(12)(13)(14)(15)(16) .…”