Implementation considerations for risk-tailored cancer screening in the population: A scoping review

Kate L A Dunlop; Nehal Singh; Hilary A Robbins; Hana Zahed; Mattias Johansson; Nicole M Rankin; Anne E Cust

doi:10.1016/j.ypmed.2024.107897

Implementation considerations for risk-tailored cancer screening in the population: A scoping review

Prev Med. 2024 Apr:181:107897. doi: 10.1016/j.ypmed.2024.107897. Epub 2024 Feb 18.

Authors

Kate L A Dunlop¹, Nehal Singh², Hilary A Robbins³, Hana Zahed³, Mattias Johansson³, Nicole M Rankin⁴, Anne E Cust⁵

Affiliations

¹ 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. Electronic address: kate.dunlop@sydney.edu.au.
² The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
³ International Agency for Research on Cancer, World Health Organization, Lyon, France.
⁴ Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
⁵ 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.

PMID: 38378124
DOI: 10.1016/j.ypmed.2024.107897

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Acceptability; Feasibility; Implementation; Risk-stratified screening; Risk-tailored screening; cancer screening.

Publication types

Review

MeSH terms

Breast Neoplasms* / diagnosis
Breast Neoplasms* / prevention & control
Early Detection of Cancer*
Female
Health Personnel
Humans

Abstract

Publication types

MeSH terms

Grants and funding