Women's decision-making regarding risk-stratified breast cancer screening and prevention from the perspective of international healthcare professionals

PLoS One. 2018 Jun 1;13(6):e0197772. doi: 10.1371/journal.pone.0197772. eCollection 2018.


Introduction: Increased knowledge of breast cancer risk factors may enable a paradigm shift from one-size-fits-all breast cancer screening to screening and subsequent prevention guided by a woman's individual risk of breast cancer. Professionals will play a key role in informing women about this new personalised screening and prevention programme. Therefore, it is essential to explore professionals' views of the acceptability of this new programme, since this may affect shared decision-making.

Methods: Professionals from three European countries (the Netherlands, United Kingdom, and Sweden) participated in digital concept mapping, a systematic mixed methods approach used to explore complex multidimensional constructs.

Results: Across the three countries, professionals prioritised the following five themes which may impact decision-making from the perspective of eligible women: (1) Anxiety/worry; (2) Proactive approach; (3) Reassurance; (4) Lack of knowledge; and (5) Organisation of risk assessment and feedback. Furthermore, Dutch and British professionals expressed concerns regarding the acceptability of a heterogeneous screening policy, suggesting women will question their risk feedback and assigned pathway of care. Swedish professionals emphasised the potential impact of the programme on family relations.

Conclusions: The perspectives of Dutch, British, and Swedish professionals of women's decision-making regarding personalised breast cancer screening and prevention generally appear in line with women's own views of acceptability as previously reported. This will facilitate shared decision-making. However, concerns regarding potential consequences of this new programme for screening outcomes and organisation need to be addressed, since this may affect how professionals communicate the programme to eligible women.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / diagnostic imaging
  • Breast Neoplasms / epidemiology*
  • Decision Making
  • Early Detection of Cancer*
  • Female
  • Health Personnel
  • Humans
  • Mammography / methods
  • Middle Aged
  • Netherlands / epidemiology
  • Risk Assessment*
  • Sweden / epidemiology
  • United Kingdom / epidemiology

Grants and funding

This work was supported by the Netherlands Organisation for Health Research and Development (ZonMW) under Grant 200500004; the Dutch Cancer Society under Grant KUN2015-7626; and the Radboud Institute of Health Sciences (RIHS), Nijmegen, the Netherlands (Grant not applicable). D Gareth Evans is an NIHR Senior investigator and is supported by the All Manchester NIHR Biomedical Research Centre. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.