The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
Prev Med. 2024 Apr;181:107897. doi: 10.1016/j.ypmed.2024.107897. Epub 2024 Feb 18.
Risk-tailored screening has emerged as a promising approach to optimise the balance of benefits and harms of existing population cancer screening programs. It tailors screening (e.g., eligibility, frequency, interval, test type) to individual risk rather than the current one-size-fits-all approach of most organised population screening programs. However, the implementation of risk-tailored cancer screening in the population is challenging as it requires a change of practice at multiple levels i.e., individual, provider, health system levels. This scoping review aims to synthesise current implementation considerations for risk-tailored cancer screening in the population, identifying barriers, facilitators, and associated implementation outcomes.
Relevant studies were identified via database searches up to February 2023. Results were synthesised using Tierney et al. (2020) guidance for evidence synthesis of implementation outcomes and a multilevel framework.
Of 4138 titles identified, 74 studies met the inclusion criteria. Most studies in this review focused on the implementation outcomes of acceptability, feasibility, and appropriateness, reflecting the pre-implementation stage of most research to date. Only six studies included an implementation framework. The review identified consistent evidence that risk-tailored screening is largely acceptable across population groups, however reluctance to accept a reduction in screening frequency for low-risk informed by cultural norms, presents a major barrier. Limited studies were identified for cancer types other than breast cancer.
Implementation strategies will need to address alternate models of delivery, education of health professionals, communication with the public, screening options for people at low risk of cancer, and inequity in outcomes across cancer types.
风险定制化筛查已成为优化现有人群癌症筛查计划效益和危害平衡的一种有前途的方法。它根据个体风险（例如，资格、频率、间隔、测试类型）来定制筛查，而不是当前大多数有组织的人群筛查计划的一刀切方法。然而，在人群中实施风险定制化癌症筛查具有挑战性，因为它需要在多个层面（即个人、提供者、卫生系统）上改变实践。本范围综述旨在综合目前人群中风险定制化癌症筛查的实施考虑因素，确定障碍、促进因素和相关实施结果。
通过数据库搜索，截至 2023 年 2 月，确定了相关研究。使用 Tierney 等人（2020 年）实施结果证据综合和多层次框架的指导，对结果进行了综合。
在 4138 个标题中，有 74 项研究符合纳入标准。本综述中的大多数研究都集中在可接受性、可行性和适当性等实施结果上，反映了迄今为止大多数研究的实施前阶段。只有六项研究包括实施框架。该综述一致证明，风险定制化筛查在人群中基本是可以接受的，然而，由于文化规范，对于低风险人群减少筛查频率的不情愿，是一个主要障碍。其他癌症类型的研究相对较少。
实施策略将需要解决替代的交付模式、卫生专业人员的教育、与公众的沟通、低癌症风险人群的筛查选择，以及不同癌症类型之间的结果不平等问题。
