Acceptability of risk‐stratified population screening across cancer types: Qualitative interviews with the Australian public

Abstract

Background There is mounting evidence of the benefit of risk‐stratified (risk‐tailored) cancer population screening, when compared to standard approaches. However, shifting towards this approach involves changes to practice that may give rise to implementation challenges. Objectives To explore the public's potential acceptance of risk‐stratified screening across different cancer types, including reducing screening frequency if at low risk and the use of personal risk information, to inform implementation strategies. Method Semi‐structured interviews were conducted with 40 public participants; half had received personal genomic risk information and half had not. Participants were prompted to consider different cancers. Data were analysed thematically as one dataset. Results Themes included the following: (a) a sense of security; (b) tailored screening is common sense; (c) risk and the need to take action; (d) not every cancer is the same; and (e) trust and belief in health messages. Both groups expressed similar views. Participants were broadly supportive of risk‐stratified screening across different cancer types, with strong support for increased screening frequency for high‐risk groups. They were less supportive of reduced screening frequency or no screening for low‐risk groups. Findings suggest the public will be amenable to reducing screening when the test is invasive and uncomfortable; be less opposed to forgo screening if offered the opportunity to screen at some stage; and view visible cancers such as melanoma differently. Conclusions Approaching distinct cancer types differently, tailoring messages for different audiences and understanding reasons for participating in screening may assist with designing future implementation strategies for risk‐stratified cancer screening.

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

“…Our participants' positive acceptance of risk stratification is consistent with findings from previous research in less informed participants that focused on specific cancer types 11–13,24,28–32 . The possibility for risk assessment to support behaviour change has also been made by members of the public previously 24 .…”

“…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. We were able to observe that among our participants this was a matter of fairness, with many initially seeking equality in screening (meaning the equal provision of and access to screening services, according to Sasieni's definition) before considering the implications and becoming more favourable to a more equitable risk‐stratified approach (attempting to equalize cancer outcomes).…”

“…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.…”

“…Our participants' positive acceptance of risk stratification is consistent with findings from previous research in less informed participants that focused on specific cancer types. 11 , 12 , 13 , 24 , 28 , 29 , 30 , 31 , 32 The possibility for risk assessment to support behaviour change has also been made by members of the public previously. 24 Despite being presented with quantitative data on the potential benefits, the scale of the benefits did not appear to be important.…”

Risk Stratification in Cost-Effectiveness Analyses of Cancer Screening: Intervention Eligibility, Strategy Choice, and Optimality

“…The capacity to benefit from screening can vary with many factors, including disease risk. It is well recognized that there can be benefits to stratifying screening intensity, 1 , 2 typically by offering higher-intensity screening to those at greater risk of disease. Current interest in screening stratification will continue to grow as our knowledge of the many determinants of disease risk expands.…”