Cancer Prevention Group, Faculty of Life Sciences & Medicine, King's College London, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK.
c/o Professor J. Waller, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
BMC Cancer. 2024 Sep 6;24(1):1111. doi: 10.1186/s12885-024-12847-w.
Risk-stratified approaches to breast screening show promise for increasing benefits and reducing harms. But the successful implementation of such an approach will rely on public acceptability. To date, research suggests that while increased screening for women at high risk will be acceptable, any de-intensification of screening for low-risk groups may be met with less enthusiasm. We report findings from a population-based survey of women in England, approaching the age of eligibility for breast screening, to compare the acceptability of current age-based screening with two hypothetical risk-adapted approaches for women at low risk of breast cancer.
An online survey of 1,579 women aged 40-49 with no personal experience of breast cancer or mammography. Participants were recruited via a market research panel, using target quotas for educational attainment and ethnic group, and were randomised to view information about (1) standard NHS age-based screening; (2) a later screening start age for low-risk women; or (3) a longer screening interval for low-risk women. Primary outcomes were cognitive, emotional, and global acceptability. ANOVAs and multiple regression were used to compare acceptability between groups and explore demographic and psychosocial factors associated with acceptability.
All three screening approaches were judged to be acceptable on the single-item measure of global acceptability (mean score > 3 on a 5-point scale). Scores for all three measures of acceptability were significantly lower for the risk-adapted scenarios than for age-based screening. There were no differences between the two risk-adapted scenarios. In multivariable analysis, higher breast cancer knowledge was positively associated with cognitive and emotional acceptability of screening approach. Willingness to undergo personal risk assessment was not associated with experimental group.
We found no difference in the acceptability of later start age vs. longer screening intervals for women at low risk of breast cancer in a large sample of women who were screening naïve. Although acceptability of both risk-adapted scenarios was lower than for standard age-based screening, overall acceptability was reasonable. The positive associations between knowledge and both cognitive and emotional acceptability suggests clear and reassuring communication about the rationale for de-intensified screening may enhance acceptability.
风险分层的乳房筛查方法显示出提高效益和减少危害的潜力。但这种方法的成功实施将依赖于公众的接受度。迄今为止，研究表明，虽然对高风险女性进行更多的筛查是可以接受的，但对低风险人群的筛查任何减少都可能不太受欢迎。我们报告了一项针对英格兰即将进入乳房筛查年龄的女性的基于人群的调查结果，该调查比较了当前基于年龄的筛查与两种针对低乳腺癌风险女性的假设风险适应筛查方法的可接受性。
对 1579 名年龄在 40-49 岁、没有乳腺癌或乳房 X 光检查个人经历的女性进行了在线调查。参与者通过市场研究小组招募，根据教育程度和族裔群体的目标配额进行随机分组，并查看以下信息：（1）标准国民保健制度（NHS）基于年龄的筛查；（2）低危女性的较晚筛查起始年龄；或（3）低危女性的较长筛查间隔。主要结果是认知、情感和整体可接受性。采用方差分析和多元回归比较组间的可接受性，并探讨与可接受性相关的人口统计学和社会心理因素。
所有三种筛查方法在单一的整体可接受性测量项目（5 分制的得分>3）上都被认为是可接受的。在所有三种可接受性测量中，风险适应情景的得分都显著低于基于年龄的筛查。两种风险适应情景之间没有差异。在多变量分析中，较高的乳腺癌知识与对筛查方法的认知和情感可接受性呈正相关。愿意进行个人风险评估与实验组无关。
在对一大群无筛查经验的女性进行的研究中，我们发现，对于低乳腺癌风险的女性来说，较晚的起始年龄与较长的筛查间隔之间的可接受性没有差异。虽然两种风险适应情景的可接受性都低于标准基于年龄的筛查，但总体可接受性是合理的。知识与认知和情感可接受性之间的正相关表明，关于减少筛查强度的合理性的清晰和令人安心的沟通可能会提高可接受性。
