Dutch women’s intended participation in a risk-based breast cancer screening and prevention programme: a survey study identifying preferences, facilitators and barriers

Abstract

Background Risk-based breast cancer screening may improve the benefit-harm ratio of screening by tailoring policy to a woman’s personal breast cancer risk. This study aims to explore Dutch women’s preferences regarding the organisation and implementation of a risk-based breast cancer screening and prevention programme, identifying potential barriers and facilitators to uptake. Methods A total of 5110 participants in the Dutch Personalised RISk-based MAmmography screening (PRISMA) study were invited, of whom 942 completed a two-part web-based survey. The first part contained questions about personal characteristics; for the second part, women were randomly assigned to one of four hypothetical breast cancer risk scenarios (i.e. low, average, moderate, or high) with subsequent tailored screening and prevention advice. Descriptive statistics are used to present women’s organisational preferences. Univariable and multivariable logistic regression analyses were performed using seven proxy measures for acceptability of risk-based screening (e.g., interest in risk) and risk-based prevention (e.g., willingness to change diet). Results Interest in breast cancer risk was high (80.3%). Higher assigned risk scenario was most consistently associated with acceptance of tailored screening and prevention recommendations. Increased acceptance of lifestyle changes was additionally associated with higher education. Having a first degree family history of breast cancer decreased women’s motivation to participate in preventative lifestyle measures. Acceptability of medication was associated with a woman’s general beliefs about the (over)use and benefit-harm balance of medication. Conclusions Dutch women generally appear in favour of receiving their breast cancer risk estimate with subsequent tailored screening and prevention recommendations. However, women’s level of acceptance depends on their assigned risk category. Offering tailored screening and prevention recommendations to low-risk women will be most challenging. Educating women on the benefits and harms of all risk-based screening and prevention strategies is key to acceptability and informed decision-making.

Organized breast cancer screening not only reduces mortality from breast cancer but also significantly decreases disability-adjusted life years: analysis of the Global Burden of Disease Study and screening programme availability in 130 countries

“…Besides, BCS needs to optimize benefits, reduce morbidity and balance adequately false-positive and false-negative rates, as highlighted by the European guidelines for BCS and diagnosis. 46 Finally, data are presented in simple terms to allow policy makers to set up their own priorities to improve BC mortality and disability within the central focus of organized BCS programmes.…”

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

“…High uptake of multifactorial personal risk assessment (PRA) is fundamental to the feasibility of RSBS. Survey studies have demonstrated that women broadly support the prospect of undergoing PRA and would be willing to receive risk feedback [ 11 , 12 , 13 , 14 ] as an opportunity for greater perceived control over their level of risk and to reduce levels of breast cancer worry [ 12 , 14 ]. Nevertheless, the Predicting Risk of Breast Cancer at Screening study (PROCAS) reported relatively low uptake of PRA, at 38% [ 15 ].…”

“…Focus-group studies have found that women’s concerns about PRA include cognitive burden, low self-efficacy [ 16 , 17 ] and emotional threat [ 16 , 17 , 18 , 19 ]. However, researchers have generally paid less attention to PRA than RSBS and have only recently started to quantitively investigate the relative acceptability of individual risk measures (e.g., lifestyle versus polygenic risk) [ 12 , 13 ].…”

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

“…There is also a consensus that for risk-based screening to be successfully implemented as part of a population-based screening program, it has to be accepted and supported by stakeholders, particularly women undergoing BC screening [ 11 , 12 ]. Burgeoning evidence from studies conducted in the United Kingdom (UK), Sweden, Netherlands, and Australia [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ] indicates that women appear to welcome the prospect of risk-stratified BC screening.…”