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

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.

Risk-Stratified Approach to Breast Cancer Screening in Canada: Women’s Knowledge of the Legislative Context and Concerns about Discrimination from Genetic and Other Predictive Health Data

“…The questionnaire was developed and translated in both English and French by the research team [ 25 ]. Details of the questionnaire design were published previously [ 25 ].…”

“…The questionnaire was developed and translated in both English and French by the research team [ 25 ]. Details of the questionnaire design were published previously [ 25 ]. The development of the questionnaire was based on previous surveys on the same topic.…”

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

“…To be successful, it also must be accepted and supported by stakeholders, including the beneficiaries (women), providers (health care professionals), and payers (health agencies). To characterize the KAB of Canadian women with respect to risk-based screening, a population-based survey of four Canadian provinces (Alberta, British Columbia, Ontario, Québec) was conducted [59]. This survey assessed attitudes towards risk-based screening including less frequent screening at lower-than-average risk and more frequent screening at high risk, breast cancer risk perception, views on genetic discrimination, knowledge of the potential use of predictive health information by insurers and employers, and perception of the potential impact of breast cancer risk assessment on insurability.…”

“…Prior to developing resources to inform women of these potential risks, it is crucial to assess their level of understanding of genetic privacy and the potential use of predictive health information by insurers and employers. Concerns about genetic discrimination and, discrimination from predictive results, are assessed in both the population survey described above for other questions [59] and in the follow-up questionnaires (described above).…”

Of Screening, Stratification, and Scores

“…Creating accurate risk stratification algorithms for cancer can require the combination of data from multiple sources, including clinical data, environmental data, lifestyle and behavioral data, and genomic data [ 43 ]. Contemporary initiatives have created breast cancer risk prediction models that incorporate both the presence of known pathogenic variants (e.g., BRCA 1 and BRCA 2) and polygenic risk scores that calculate a risk-score expressing the cumulative risk arising from the presence of multiple genetic variants that individually create small increases in genetic risk [ 44 , 45 , 46 ].…”