Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Manchester, UK.
Nightingale and Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, UK.
Womens Health (Lond). 2021 Jan-Dec;17:17455065211009746. doi: 10.1177/17455065211009746.
Proposals to stratify breast screening by breast cancer risk aim to produce a better balance of benefits to harms. Notably, risk estimation calculated from common risk factors and a polygenic risk score would enable high-risk women to benefit from more frequent screening or preventive medication. This service would also identify low-risk women who experience fewer benefits from attending, as lower grade and in situ cancers may be treated unnecessarily. It may therefore be appropriate for low-risk women to attend screening less. This study aimed to elicit views regarding implementing less frequent screening for low-risk women from healthcare professionals who implement risk-stratified screening.
Healthcare professionals involved in the delivery of risk-stratified breast screening were invited to participate in a focus group within the screening setting in which they work or have a telephone interview. Primary care staff were also invited to provide their perspective. Three focus groups and two telephone interviews were conducted with 28 healthcare professionals. To identify patterns across the sample, data were analysed as a single dataset using reflexive thematic analysis.
Analysis yielded three themes: , highlighting healthcare professionals' unease and concerns towards implementing less frequent screening; , providing views on media impact on public opinion and the potential for a low-risk pathway to cause confusion and raise suspicion regarding implementation motives; and , where the practicalities of implementation are discussed.
Healthcare professionals broadly supported less frequent screening but had concerns about implementation. It will be essential to address concerns regarding risk estimate accuracy, healthcare professional confidence, service infrastructure and public communication prior to introducing less frequent screening for low-risk women.
通过乳腺癌风险分层来提出筛查建议，旨在实现获益与危害之间更好的平衡。值得注意的是，通过常见风险因素和多基因风险评分计算出的风险估计值，将使高风险女性受益于更频繁的筛查或预防性药物治疗。这项服务还将识别出从参加筛查中获益较少的低风险女性，因为可能会不必要地治疗较低级别和原位癌。因此，低风险女性可能适当减少参加筛查的频率。本研究旨在从实施风险分层筛查的医疗保健专业人员那里征求关于对低风险女性实施较少频率筛查的意见。
邀请参与实施风险分层乳腺癌筛查的医疗保健专业人员在他们工作或进行电话访谈的筛查环境中参加焦点小组。还邀请了初级保健人员提供他们的观点。对 28 名医疗保健专业人员进行了三次焦点小组和两次电话访谈。为了在样本中识别出模式，使用反思性主题分析对数据进行了单一数据集分析。
分析产生了三个主题：“对减少低风险女性筛查频率的担忧”，突出了医疗保健专业人员对实施较少频率筛查的不安和担忧；“媒体对公众舆论的影响和低风险途径的潜在影响”，提供了对媒体对公众舆论的影响以及低风险途径可能导致混乱和对实施动机产生怀疑的看法；以及“实施的实际情况”，讨论了实施的实际情况。
医疗保健专业人员普遍支持减少低风险女性的筛查频率，但对实施情况存在一些担忧。在为低风险女性引入较少频率的筛查之前，必须解决风险估计准确性、医疗保健专业人员信心、服务基础设施和公众沟通方面的担忧。
