Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Breast. 2018 Jun;39:24-32. doi: 10.1016/j.breast.2018.02.029. Epub 2018 Mar 10.
Increased knowledge of breast cancer risk factors provides opportunities to shift from a one-size-fits-all screening programme to a personalised approach, where screening and prevention is based on a woman's risk of developing breast cancer. However, potential implementation of this new paradigm could present considerable challenges which the present review aims to explore.
Bibliographic databases were searched to identify studies evaluating potential implications of the implementation of personalised risk-based screening and primary prevention for breast cancer. Identified themes were evaluated using thematic analysis.
The search strategy identified 5699 unique publications, of which 59 were selected for inclusion. Significant changes in policy and practice are warranted. The organisation of breast cancer screening spans several healthcare delivery systems and clinical settings. Feasibility of implementation depends on how healthcare is funded and arranged, and potentially varies between countries. Piloting risk assessment and prevention counselling in primary care settings has highlighted implications relating to the need for extensive additional training on risk (communication) and prevention, impact on workflow, and professionals' personal discomfort breaching the topic with women. Additionally, gaps in risk estimation, psychological, ethical and legal consequences will need to be addressed.
The present review identified considerable unresolved issues and challenges. Potential implementation will require a more complex framework, in which a country's healthcare regulations, resources, and preferences related to screening and prevention services are taken into account. However, with the insights gained from the present overview, countries expecting to implement risk-based screening and prevention can start to inventory and address the issues that were identified.
对乳腺癌危险因素认识的提高为从一刀切的筛查方案向个体化方法转变提供了机会，这种方法依据女性患乳腺癌的风险来进行筛查和预防。然而，这种新方法的潜在实施可能会带来相当大的挑战，本综述旨在探讨这些挑战。
通过文献数据库检索，评估了实施基于个体风险的乳腺癌筛查和一级预防的潜在影响。采用主题分析法对确定的主题进行评估。
该检索策略共确定了 5699 项独特的出版物，其中 59 项被选入。需要对政策和实践进行重大调整。乳腺癌筛查的组织涉及多个医疗保健提供系统和临床环境。实施的可行性取决于医疗保健的资金和安排方式，并且在国家之间可能存在差异。在初级保健环境中进行风险评估和预防咨询的试点研究凸显了与风险（沟通）和预防相关的广泛额外培训、对工作流程的影响以及专业人员在与女性讨论该话题时的个人不适等问题。此外，还需要解决风险估计、心理、伦理和法律后果方面的差距。
本综述确定了许多尚未解决的问题和挑战。潜在的实施将需要一个更复杂的框架，其中考虑到一个国家的医疗保健法规、资源以及与筛查和预防服务相关的偏好。然而，通过本次综述获得的见解，计划实施基于风险的筛查和预防的国家可以开始清查并解决已确定的问题。
