Extending screening intervals for women at low risk of breast cancer: do they find it acceptable?

Abstract

Background Trials of risk estimation in breast cancer screening programmes, in order to identify women at higher risk and offer extra screening/preventive measures, are ongoing. It may also be feasible to introduce less frequent screening for women at low-risk of breast cancer. This study aimed to establish views of women at low-risk of breast cancer regarding the acceptability of extending breast screening intervals for low-risk women beyond 3 y. Methods Semi-structured interviews were used to explore views of low-risk women, where “low-risk” was defined as less than 2% estimated 10-year risk of breast cancer aged > 46 years. Low-risk women were identified via the BC-Predict study, where following routine screening, women were given their 10-year risk of breast cancer by letter, along with additional information explaining breast cancer risk factors. To gain diversity of views, purposive sampling by ethnicity and socioeconomic background was used to recruit women. Data were analysed using thematic analysis. Results Twenty-three women participated in individual interviews. Three themes are reported: (1) A good opportunity to receive risk estimation, where women found it worthwhile to receive a low-risk result although some were surprised if expecting a higher risk result; (2) Multi-faceted acceptability of extended screening intervals, with reactions to less frequent screening dependent on whether women were confident in being low-risk status and current safety evidence, (3) Passive approval versus informed choice, highlighting that women found it difficult to consider choosing less frequent screening without professionals’ recommendations, as they generally viewed attending breast screening as positive. Conclusions Risk assessment and receiving a low-risk of breast cancer is acceptable although, further research is required with more diverse samples of women. Any recommendation of less frequent screening in this risk group should be evidence-based in order to be acceptable. Communication needs to be carefully developed, with a focus on ensuring informed choice, prior to trialling any extended screening recommendations in future studies.

UK Women’s Views of the Concepts of Personalised Breast Cancer Risk Assessment and Risk-Stratified Breast Screening: A Qualitative Interview Study

“…This is consistent with UK surveys demonstrating that between 53% and 58.5% of women would consider a screening interval of 4–5 years if they were assessed as low-risk [ 14 , 20 ]. Our findings also correspond to McWilliams et al, who found the acceptability of less frequent screening at low-risk to be contingent to perceived accuracy of PRA and evidence-based low-risk screening recommendations [ 26 ]. Although ’overall acceptors’ had mixed responses to foregoing screening if assessed as very low-risk, some thought this option would be acceptable with individual guidance concerning the balance of screening benefits and harms and/or were able to perceive this as more acceptable for younger women un-endowed with NHSBSP experience.…”

“…This work introduced women to PRA and RSBS and explored their thoughts and feelings about the prospect of incorporating this approach within the NHSBSP. To date, there has only been one qualitative interview study assessing the acceptability of this novel screening approach amongst UK women [ 26 ]. As McWilliams and colleagues aimed to explore women’s perceptions of extended screening intervals having been identified as low-risk through their participation with the BC-Predict study [ 27 ], this is the first study to provide a more comprehensive overview of how women think and feel about the prospect RSBS as a whole.…”

“…As we explored RSBS as a whole, rather than focusing on a specific risk level [ 26 ] or ethnic group [ 32 ], we were able to identify three distinct responses to the concept. Previous research has demonstrated significantly greater acceptability for high-risk over low-risk screening options [ 11 , 13 , 14 ].…”

“…Although we outlined screening harms in more detail that previous studies [ 12 , 13 , 19 , 20 , 21 ], women still required some prompting to consider these when formulating their responses to screening scenarios, especially low-risk screening options. Although UK women’s lack of awareness and understanding of screening harms has been widely documented [ 35 ], the need to address this will be crucial to the wider acceptability of RSBS [ 26 ].…”

A community jury study exploring the public acceptability of using risk stratification to determine eligibility for cancer screening

“…Such concerns around accepting reduced screening for those at low risk have been reported previously. 13,14,28,[30][31][32]35 Coupled with findings that overdetection in population screening is acceptable to the public and that many are willing to undergo diagnostic testing regardless of cancer risk, 36,37 this reinforces the relatively low importance placed by the public on the potential harms of screening people at low risk.…”