The introduction of risk stratified screening into the NHS breast screening Programme: views from British-Pakistani women

Woof, Victoria G.; Ruane, Helen; French, David P.; Ulph, Fiona; Qureshi, Nadeem; Khan, Nasaim; Evans, D. Gareth; Donnelly, Louise S.

doi:10.1186/s12885-020-06959-2

Cited by 24 publications

(64 citation statements)

References 34 publications

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“…Communication around such changes to breast screening, that could be considered de-implementation of a service, should however be carefully handled especially to minimise misunderstanding, as highlighted in interviews with UK screening figures and screening professionals [ 16 , 17 ]. In addition, communication materials should be developed in consideration of the ethnic diversity of the population likely to be invited given that previous research identified that British-Pakistani women were enthusiastic about risk-stratified screening [ 34 ] although described barriers to attending the NHSBSP including lack of knowledge about breast screening [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…This is particularly important given the high educational attainment of the present sample as evidence suggests lower uptake and poorer understanding of risk is associated with socioeconomic status, such as qualifications [ 36 ]. Future research should be conducted with women from diverse backgrounds as although previous research highlighted that British-Pakistani women were interested in breast cancer risk assessment, including many where English was a second language, views may vary across other ethnic groups [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

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Extending screening intervals for women at low risk of breast cancer: do they find it acceptable?

et al. 2021

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Background Trials of risk estimation in breast cancer screening programmes, in order to identify women at higher risk and offer extra screening/preventive measures, are ongoing. It may also be feasible to introduce less frequent screening for women at low-risk of breast cancer. This study aimed to establish views of women at low-risk of breast cancer regarding the acceptability of extending breast screening intervals for low-risk women beyond 3 y. Methods Semi-structured interviews were used to explore views of low-risk women, where “low-risk” was defined as less than 2% estimated 10-year risk of breast cancer aged > 46 years. Low-risk women were identified via the BC-Predict study, where following routine screening, women were given their 10-year risk of breast cancer by letter, along with additional information explaining breast cancer risk factors. To gain diversity of views, purposive sampling by ethnicity and socioeconomic background was used to recruit women. Data were analysed using thematic analysis. Results Twenty-three women participated in individual interviews. Three themes are reported: (1) A good opportunity to receive risk estimation, where women found it worthwhile to receive a low-risk result although some were surprised if expecting a higher risk result; (2) Multi-faceted acceptability of extended screening intervals, with reactions to less frequent screening dependent on whether women were confident in being low-risk status and current safety evidence, (3) Passive approval versus informed choice, highlighting that women found it difficult to consider choosing less frequent screening without professionals’ recommendations, as they generally viewed attending breast screening as positive. Conclusions Risk assessment and receiving a low-risk of breast cancer is acceptable although, further research is required with more diverse samples of women. Any recommendation of less frequent screening in this risk group should be evidence-based in order to be acceptable. Communication needs to be carefully developed, with a focus on ensuring informed choice, prior to trialling any extended screening recommendations in future studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Extending screening intervals for women at low risk of breast cancer: do they find it acceptable?

et al. 2021

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“…As we explored RSBS as a whole, rather than focusing on a specific risk level [ 26 ] or ethnic group [ 32 ], we were able to identify three distinct responses to the concept. Previous research has demonstrated significantly greater acceptability for high-risk over low-risk screening options [ 11 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, women from low SES and non-White ethnic backgrounds traditionally associated with non-engagement with the NHSBSP [ 37 ] were under-represented in our sample and may have different views. Consequently, further research is required to explore the attitudes of ‘hard to reach’ populations towards PRA and RSBS [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

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

Kelley-Jones

Scott

Waller

2021

Cancers

120

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Any introduction of risk-stratification within the NHS Breast Screening Programme needs to be considered acceptable by women. We conducted interviews to explore women’s attitudes to personalised risk assessment and risk-stratified breast screening. Twenty-five UK women were purposively sampled by screening experience and socioeconomic background. Interview transcripts were qualitatively analysed using Framework Analysis. Women expressed positive intentions for personal risk assessment and willingness to receive risk feedback to provide reassurance and certainty. Women responded to risk-stratified screening scenarios in three ways: ‘Overall acceptors’ considered both high- and low-risk options acceptable as a reasonable allocation of resources to clinical need, yet acceptability was subject to specified conditions including accuracy of risk estimates and availability of support throughout the screening pathway. Others who thought ‘more is better’ only supported high-risk scenarios where increased screening was proposed. ‘Screening sceptics’ found low-risk scenarios more aligned to their screening values than high-risk screening options. Consideration of screening recommendations for other risk groups had more influence on women’s responses than screening-related harms. These findings demonstrate high, but not universal, acceptability. Support and guidance, tailored to screening values and preferences, may be required by women at all levels of risk.

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“…In developing BC-Predict, interviews with a cohort of British-Pakistani women from low socioeconomic backgrounds found that views toward risk-stratified screening are favourable. However, as with the present screening programme language barriers could still prevent access and reduce women's ability to make informed decisions [27]. Given this, in the present study we will assess whether women from low socioeconomic status backgrounds are less likely to take up the offer of riskstratified screening.…”

Section: Introductionmentioning

confidence: 98%

What are the benefits and harms of risk stratified screening as part of the NHS breast screening Programme? Study protocol for a multi-site non-randomised comparison of BC-predict versus usual screening (NCT04359420)

et al. 2020

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Background In principle, risk-stratification as a routine part of the NHS Breast Screening Programme (NHSBSP) should produce a better balance of benefits and harms. The main benefit is the offer of NICE-approved more frequent screening and/ or chemoprevention for women who are at increased risk, but are unaware of this. We have developed BC-Predict, to be offered to women when invited to NHSBSP which collects information on risk factors (self-reported information on family history and hormone-related factors via questionnaire; mammographic density; and in a sub-sample, Single Nucleotide Polymorphisms). BC-Predict produces risk feedback letters, inviting women at high risk (≥8% 10-year) or moderate risk (≥5 to < 8% 10-year) to have discussion of prevention and early detection options at Family History, Risk and Prevention Clinics. Despite the promise of systems such as BC-Predict, there are still too many uncertainties for a fully-powered definitive trial to be appropriate or ethical. The present research aims to identify these key uncertainties regarding the feasibility of integrating BC-Predict into the NHSBSP. Key objectives of the present research are to quantify important potential benefits and harms, and identify key drivers of the relative cost-effectiveness of embedding BC-Predict into NHSBSP. Methods A non-randomised fully counterbalanced study design will be used, to include approximately equal numbers of women offered NHSBSP (n = 18,700) and BC-Predict (n = 18,700) from selected screening sites (n = 7). In the initial 8-month time period, women eligible for NHSBSP will be offered BC-Predict in four screening sites. Three screening sites will offer women usual NHSBSP. In the following 8-months the study sites offering usual NHSBSP switch to BC-Predict and vice versa. Key potential benefits including uptake of risk consultations, chemoprevention and additional screening will be obtained for both groups. Key potential harms such as increased anxiety will be obtained via self-report questionnaires, with embedded qualitative process analysis. A decision-analytic model-based cost-effectiveness analysis will identify the key uncertainties underpinning the relative cost-effectiveness of embedding BC-Predict into NHSBSP. Discussion We will assess the feasibility of integrating BC-Predict into the NHSBSP, and identify the main uncertainties for a definitive evaluation of the clinical and cost-effectiveness of BC-Predict. Trial registration Retrospectively registered with clinicaltrials.gov (NCT04359420).

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The introduction of risk stratified screening into the NHS breast screening Programme: views from British-Pakistani women

Cited by 24 publications

References 34 publications

Extending screening intervals for women at low risk of breast cancer: do they find it acceptable?

Extending screening intervals for women at low risk of breast cancer: do they find it acceptable?

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

What are the benefits and harms of risk stratified screening as part of the NHS breast screening Programme? Study protocol for a multi-site non-randomised comparison of BC-predict versus usual screening (NCT04359420)

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