Public interest in and acceptability of the prospect of risk-stratified screening for breast and prostate cancer

Abstract

background. For risk-stratified screening to be implemented as a screening program for breast and prostate cancer it has to be accepted among the general population. Investigating public interest in stratified screening and its acceptability to the public is therefore essential since as yet little is known. Method. Cross-sectional web survey sent to a sample of 10 000 individuals (20-74 years of age) representative of the Swedish population as registered in 2009. results. Among the responders (28%), a vast majority (94%) expressed an interest in knowing their breast or prostate cancer risk and stated wanting to know to 'avoid worrying'. Men and women were equally interested in knowing their prostate and breast cancer risk, respectively. However, men showed more certainty. Trusting the healthcare workers with personal information (63%) as well as genetic information (70%), in order to calculate the risk, did not seem to be a major issue. Furthermore, 87% would agree to get screened more often if identified with a high risk, whereas, if identified with a low risk, only 27% would agree to get screened less often. Finally, although a consultation with a physician seemed to be the preferred way to communicate the risk, a majority would agree to receive it via a letter or a phone call. conclusion. Risk-stratified screening has the possibility to be accepted by the general public. Knowledge about interest and acceptability of the prospect of risk-stratified screening for breast and prostate cancer will help when implementing new screening strategies.

What's new in screening in 2015?

“…[106] Further, pre-screening discussions correlate with PSA uptake[105], either increasing or decreasing PSA screening rates depending on how the discussion about advantages and disadvantages go or how the decision-aid is framed; typically decision-aids for PC screening reduces men's interest in PSA and makes them lean away from having the test[107]. The format can also play a role and based on several publications it is obvious that there is no one size fits all[108–111] and that when confronted with the question to screen or not to screen, men want to know their risk and express acceptance to risk-stratified screening approaches such as more frequent screening if high risk and less frequent screening if low risk[112]. …”

Evaluating the Integration of Genomics into Cancer Screening Programmes: Challenges and Opportunities

“…The evidence for acceptability of screening for CSGs is positive to date. Several recent trials have suggested public support for population genetic testing for CSGs or screening stratified by PRS [9,[33][34][35]. However, a consequent reduction in screening for low-risk groups was a concern to those questioned [34].…”

“…However, a consequent reduction in screening for low-risk groups was a concern to those questioned [34]. In one questionnaire-based study of screening stratified by PRS just 27%, of almost 3000 individuals, said they would accept less frequent screening if considered low risk [35]. Thus it seems unlikely that this approach would gain public approval [5••], and this may prove a barrier to maximising the efficacy and cost-effectiveness of such programmes.…”

“…In addition, the personal utility and empowerment of health ownership through genetic knowledge may be considerable, though there is a tension with the difficulties and provider responsibility of accurately explaining potentially unvalidated or uncertain risks [15]. Risk stratification may similarly have considerable personal utility [34,35], and may improve benefit-to-harm ratio by reducing overdiagnosis in low-risk individuals [11].…”

Recommendations on Breast Cancer Screening and Prevention in the Context of Implementing Risk Stratification: Impending Changes to Current Policies

“…With several major ongoing initiatives recently launched in Canada, the United States, and Europe to accelerate research for the development of personalized approaches in disease prevention and precision medicine [31][32][33] , risk stratification could become part of clinical practice sooner than expected 14,20,22 . In that context, several studies have recently evaluated the public interest in, and the acceptability of, population-based risk-stratified screening for breast cancer [34][35][36] .…”