Lippey Jocelyn, Keogh Louise, Best Stephanie, Purvis Rebecca, Mann Gregory Bruce, Forrest Laura
Department of Surgery, St. Vincent's Hospital, 44 Victoria Pde, Fitzroy, Melbourne, VIC, 3065, Australia.
Department of Surgery, University of Melbourne, Parkville, Melbourne, VIC, 3052, Australia.
Arch Public Health. 2025 Sep 1;83(1):223. doi: 10.1186/s13690-025-01690-5.
Risk-based breast cancer screening would be a dramatic shift from the current one-size-fits-all model to a tailored approach where screening modality and frequency is directed by individual risk. This project assesses what key stakeholders, defined as those holding managerial and decision-making roles within BreastScreen, consider the issues are with implementing a risk-based approach to screening.
A qualitative approach was undertaken, recruiting participants through professional networks with interviews guided by the Consolidated Framework of Implementation Research (CFIR). Participants were key stakeholders defined as those managing, overseeing and influencing Breast Screen throughout Australia. Data were deductively coded against a CFIR-informed codebook, followed by content analysis per CFIR domain.
Twenty interviews were conducted with 21 participants. 144 initial codes consolidated into 17 final themes. Key stakeholders are supportive and optimistic about risk-based screening in principle; however several issues exist, including knowledge gaps precluding support of evidence-based implementation. Concerns about worsening inequities within screening, cost and communication with clients are major issues key stakeholders consider important to address in the planning and implementing a change to the program.
Key stakeholders in Australia were overwhelmingly enthusiastic about the benefits of a risk-based approach however there are concerns about risk assessment utility, cost and the potential risk to equity in the program. Systematic assessment of these concerns will be required to facilitate successful change to the well-established breast screening program in Australia should risk-stratification be undertaken.
基于风险的乳腺癌筛查将从当前的一刀切模式大幅转向一种量身定制的方法，即筛查方式和频率由个体风险决定。本项目评估了关键利益相关者（定义为在乳腺癌筛查机构中担任管理和决策角色的人员）认为实施基于风险的筛查方法存在哪些问题。
采用定性研究方法，通过专业网络招募参与者，并以实施研究综合框架（CFIR）为指导进行访谈。参与者是关键利益相关者，定义为在澳大利亚各地管理、监督和影响乳腺癌筛查的人员。数据根据基于CFIR的编码手册进行演绎编码，然后按CFIR领域进行内容分析。
对21名参与者进行了20次访谈。144个初始编码合并为17个最终主题。关键利益相关者原则上支持并看好基于风险的筛查；然而，存在一些问题，包括知识差距妨碍了对循证实施的支持。对筛查中不平等加剧、成本以及与客户沟通的担忧是关键利益相关者认为在规划和实施项目变革时需要解决的重要问题。
澳大利亚的关键利益相关者对基于风险的方法的益处极为热情，但对风险评估效用、成本以及该项目中公平性的潜在风险存在担忧。如果要进行风险分层，需要对这些担忧进行系统评估，以促进澳大利亚成熟的乳腺癌筛查项目的成功变革。
