Risk-Adapted Breast Screening for Women at Low Predicted Risk of Breast Cancer: An Online Discrete Choice Experiment

Abstract

Background A risk-stratified breast screening program could offer low-risk women less screening than is currently offered by the National Health Service. The acceptability of this approach may be enhanced if it corresponds to UK women’s screening preferences and values. Objectives To elicit and quantify preferences for low-risk screening options. Methods Women aged 40 to 70 y with no history of breast cancer took part in an online discrete choice experiment. We generated 32 hypothetical low-risk screening programs defined by 5 attributes (start age, end age, screening interval, risk of dying from breast cancer, and risk of overdiagnosis), the levels of which were systematically varied between the programs. Respondents were presented with 8 choice sets and asked to choose between 2 screening alternatives or no screening. Preference data were analyzed using conditional logit regression models. The relative importance of attributes and the mean predicted probability of choosing each program were estimated. Results Participants ( N = 502) preferred all screening programs over no screening. An older starting age of screening, younger end age of screening, longer intervals between screening, and increased risk of dying had a negative impact on support for screening programs ( P < 0.01). Although the risk of overdiagnosis was of low relative importance, a decreased risk of this harm had a small positive impact on screening choices. The mean predicted probabilities that risk-adapted screening programs would be supported relative to current guidelines were low (range, 0.18 to 0.52). Conclusions A deintensified screening pathway for women at low risk of breast cancer, especially one that recommends a later screening start age, would run counter to women’s breast screening preferences. Further research is needed to enhance the acceptability of offering less screening to those at low risk of breast cancer. Highlights Risk-based breast screening may involve the deintensification of screening for women at low risk of breast cancer. Low-risk screening pathways run counter to women’s screening preferences and values. Longer screening intervals may be preferable to a later start age. Work is needed to enhance the acceptability of a low-risk screening pathway.