Optimising the delivery of breast cancer risk assessment for women aged 30-39 years: A qualitative study of women's views

Acceptability and perceptions of personalised risk-based cancer screening among health-care professionals and the general public: a systematic review and meta-analysis

BACKGROUND

Personalised risk-based screening (PRBS) can enhance the efficiency of cancer screening programnes, but little is known about support for its implementation among the general public and health-care professionals. We aimed to summarise the acceptability and perceptions of PRBS for breast, cervical, colorectal, lung, and prostate cancer screening among these groups.

METHODS

We conducted a systematic review and meta-analysis of original research studies reporting on breast, cervical, colorectal, lung, and prostate cancer screening; personalised risk assessments to guide PRBS; and the acceptability of and receptibility towards these approaches among the general public, health-care professionals, or both. We searched MEDLINE, Embase, Cochrane Central, PsycINFO, and CINAHL Plus for articles published between Jan 1, 2010, and April 30, 2024. Studies not reporting on the outcomes of interest and with insufficient data for analysis were excluded. Six reviewers independently screened articles, and risk of bias was assessed using the Mixed Methods Appraisal Tool. Qualitative data were analysed thematically. Quantitative data were analysed with use of random-effects meta-analysis for outcomes that had at least two studies. The study protocol was registered at PROSPERO, CRD42022354287.

FINDINGS

Our search identified 4491 unique records. After screening, 63 studies were included in our analysis, of which 36 (57%) included the general public, 21 (33%) included health-care professionals, and six (11%) included both. The majority of studies focused on breast cancer screening (43 [68%] studies), and were from North America (28 [44%]) and Europe (28 [44%]). Qualitative findings were analysed thematically, and the extracted quantitative findings were synthesised under the following topics: acceptability and perceptions of personalised risk assessments among the general public; acceptability and perceptions of PRBS among the general public; acceptability and perceptions of PRBS among health-care professionals; and barriers and facilitators to PRBS implementation among health-care professionals. The general public and health-care professionals generally found PRBS acceptable, but they needed more information about how risk was calculated and the accuracy of risk scores. Additionally, both groups were cautious about reducing screening frequencies for individuals at low risk and cited barriers such as the time and resources needed to implement an effective PRBS programme. The pooled estimate for acceptability of PRBS was 78% (95% CI 66-88) among the general public and 86% (64-99) among health-care professionals.

INTERPRETATION

The general public and health-care professionals both viewed personalised risk assessments as providing valuable information and PRBS as a logical next step to increase the quality of patient care and improve cancer mortality. However, implementation barriers at the public, health-care professional, and system level need to be addressed.

FUNDING

National Cancer Institute and Cancer Prevention and Research Institute of Texas.

Experiences of a Digital Behavior Change Intervention to Prevent Weight Gain and Promote Risk-Reducing Health Behaviors for Women Aged 18 to 35 Years at Increased Risk of Breast Cancer: Qualitative Interview Study

BACKGROUND

Breast cancer is the most common form of cancer in women. Adult weight gain and modifiable health behaviors, including smoking, alcohol intake, and lack of physical activity, are well-known risk factors. Most weight gain in women occurs between the ages of 18 and 35 years. Digital interventions have the potential to address logistical challenges that arise in reaching women in this age range. We designed a digital intervention targeting weight gain prevention and other modifiable health behaviors for young women at increased risk of breast cancer. Women aged 18 to 35 years were recruited to this single-arm intervention study over 2 months to test the acceptability and usability of the intervention, which comprised a group welcome event held via videoconferencing, app, and private Facebook group.

OBJECTIVE

This nested qualitative substudy explored women's views and experiences of being part of the digital health intervention to inform future intervention development for a feasibility study.

METHODS

A total of 20 women aged 23 to 35 years who were at increased risk of breast cancer were interviewed via telephone within 1 month after completing the intervention, between February 2023 and March 2023. The women were asked about their experiences of the digital intervention and the extent to which it may have influenced their health behaviors. Data were analyzed thematically and organized using the framework approach.

RESULTS

The interviews lasted for a median of 37 (IQR 30-46) minutes. Overall, the women perceived the digital health intervention comprising education, tracking, and support to be acceptable for weight gain prevention. In total, 4 themes were generated. A "missed opportunity" in breast cancer prevention services encompasses the lack of services that currently exist for young women at increased risk of breast cancer. The pros and cons of being part of a community encompasses the divergent views that the women had regarding engaging with other women at increased risk. The importance of an interactive app focuses on features that the women would want from the app to promote engagement with the intervention. The different wants and needs of different age groups highlights that an intervention such as this one would need to be customizable to suit the needs of women at different life stages.

CONCLUSIONS

There is an unmet need in prevention services for young women aged 18 to 35 years at increased risk of breast cancer. The women perceived the app to be an acceptable intervention for weight gain prevention but emphasized that the intervention would need to be customizable to meet the needs of different age groups within the group of women aged 18 to 35 years. The digital intervention could be a scalable behavior change strategy for UK family history clinics.

Feasibility and acceptability of offering breast cancer risk assessment to general population women aged 30-39 years: a mixed-methods study protocol

INTRODUCTION

Breast cancer incidence starts to increase exponentially when women reach 30-39 years, hence before they are eligible for breast cancer screening. The introduction of breast cancer risk assessment for this age group could lead to those at higher risk receiving benefits of earlier screening and preventive strategies. Currently, risk assessment is limited to women with a family history of breast cancer only. The Breast CANcer Risk Assessment in Younger women (BCAN-RAY) study is evaluating a comprehensive breast cancer risk assessment strategy for women aged 30-39 years incorporating a questionnaire of breast cancer risk factors, low-dose mammography to assess breast density and polygenic risk. This study will assess the feasibility and acceptability of the BCAN-RAY risk assessment strategy.

METHODS AND ANALYSIS

This study involves women undergoing risk assessment as part of the BCAN-RAY case-control study (n=750). They will be aged 30-39 years without a strong family history of breast cancer and invited to participate via general practice. A comparison of uptake rates by socioeconomic status and ethnicity between women who participated in the BCAN-RAY study and women who declined participation will be conducted. All participants will be asked to complete self-report questionnaires to assess key potential harms including increased state anxiety (State Trait Anxiety Inventory), cancer worry (Lerman Cancer Worry Scale) and satisfaction with the decision to participate (Decision Regret Scale), alongside potential benefits such as feeling more informed about breast cancer risk. A subsample of approximately 24 women (12 at average risk and 12 at increased risk) will additionally participate in semistructured interviews to understand the acceptability of the risk assessment strategy and identify any changes needed to it to increase uptake.

ETHICS AND DISSEMINATION

Ethical approval was granted by North West-Greater Manchester West Research Ethics Committee (reference: 22/NW/0268). Study results will be disseminated through peer-reviewed journals, conference presentations and charitable organisations.

TRIAL REGISTRATION NUMBER

NCT05305963.

"I don't know what I'm feeling for": young women's beliefs about breast cancer risk and experiences of breast awareness

BACKGROUND

Younger women are often diagnosed with advanced breast cancer. Beliefs about risk are instrumental in motivating many health protective behaviours, but there may be confusion around which behaviour is appropriate to detect breast cancer earlier. Breast awareness, defined as an understanding of how the breasts look and feel so changes can be identified early, is widely recommended. In contrast, breast self-examination involves palpation using a specified method. We aimed to investigate young women's beliefs about their risk and experiences of breast awareness.

METHODS

Thirty-seven women aged 30-39 years residing in a North West region of England with no family or personal history of breast cancer participated in seven focus groups (n = 29) and eight individual interviews. Data were analysed using reflexive thematic analysis.

RESULTS

Three themes were generated. "Future me's problem" describes why women perceive breast cancer as an older woman's disease. Uncertainty regarding checking behaviours highlights how confusion about self-checking behaviour advice has resulted in women infrequently performing breast checks. Campaigns as a missed opportunity highlights the potential negative effects of current breast cancer fundraising campaigns and the perceived absence of educational campaigning about breast cancer for this demographic.

CONCLUSIONS

Young women expressed low perceived susceptibility to developing breast cancer in the near future. Women did not know what breast self-checking behaviours they should be performing and expressed a lack of confidence in how to perform a breast check appropriately due to limited knowledge about what to look and feel for. Consequently, women reported disengagement with breast awareness. Defining and clearly communicating the best strategy for breast awareness and establishing whether it is beneficial or not are essential next steps.