Linda Rainey1, Daniëlle van der Waal2, Anna Jervaeus3, Yvonne Wengström3, D Gareth Evans4, Louise S Donnelly5, Mireille J M Broeders6. 1. Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Electronic address: Linda.Rainey@Radboudumc.nl. 2. Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. 3. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet & Theme Cancer, Karolinska University Hospital, Alfred Nobels allé 23, 23300, 14183, Huddinge, Sweden. 4. Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom; Genomic Medicine, Division of Evolution and Genomic Sciences, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester M13 9WL, United Kingdom; The Christie NHS Foundation Trust, Withington, Manchester M20 4BX, United Kingdom. 5. Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom. 6. Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands; Dutch Expert Center for Screening, PO Box 6873, 6503 GJ Nijmegen, The Netherlands.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Linda Rainey; Anna Jervaeus; Louise S Donnelly; D Gareth Evans; Mattias Hammarström; Per Hall; Yvonne Wengström; Mireille J M Broeders; Daniëlle van der Waal Journal: Psychooncology Date: 2019-03-25 Impact factor: 3.894
Authors: Svetlana Puzhko; Justin Gagnon; Jacques Simard; Bartha Maria Knoppers; Sophia Siedlikowski; Gillian Bartlett Journal: Public Health Rev Date: 2019-02-28
Authors: Victoria G Woof; Lorna McWilliams; Louise S Donnelly; Anthony Howell; D Gareth Evans; Anthony J Maxwell; David P French Journal: Womens Health (Lond) Date: 2021 Jan-Dec
Authors: Celmira Laza-Vásquez; María José Hernández-Leal; Misericòrdia Carles-Lavila; Maria José Pérez-Lacasta; Inés Cruz-Esteve; Montserrat Rué Journal: Int J Environ Res Public Health Date: 2022-01-27 Impact factor: 3.390
Authors: Celmira Laza-Vásquez; Núria Codern-Bové; Àngels Cardona-Cardona; Maria José Hernández-Leal; Maria José Pérez-Lacasta; Misericòrdia Carles-Lavila; Montserrat Rué Journal: PLoS One Date: 2022-02-04 Impact factor: 3.240
Authors: Lorna McWilliams; Victoria G Woof; Louise S Donnelly; Anthony Howell; D Gareth Evans; David P French Journal: BMC Cancer Date: 2020-07-22 Impact factor: 4.430
Authors: Linda Rainey; Daniëlle van der Waal; Anna Jervaeus; Louise S Donnelly; D Gareth Evans; Mattias Hammarström; Per Hall; Yvonne Wengström; Mireille J M Broeders Journal: BMC Cancer Date: 2020-03-24 Impact factor: 4.430
Authors: Nora Pashayan; Antonis C Antoniou; Urska Ivanus; Laura J Esserman; Douglas F Easton; David French; Gaby Sroczynski; Per Hall; Jack Cuzick; D Gareth Evans; Jacques Simard; Montserrat Garcia-Closas; Rita Schmutzler; Odette Wegwarth; Paul Pharoah; Sowmiya Moorthie; Sandrine De Montgolfier; Camille Baron; Zdenko Herceg; Clare Turnbull; Corinne Balleyguier; Paolo Giorgi Rossi; Jelle Wesseling; David Ritchie; Marc Tischkowitz; Mireille Broeders; Dan Reisel; Andres Metspalu; Thomas Callender; Harry de Koning; Peter Devilee; Suzette Delaloge; Marjanka K Schmidt; Martin Widschwendter Journal: Nat Rev Clin Oncol Date: 2020-06-18 Impact factor: 65.011