Breast cancer risk assessment and screening for young women at high risk: Developing care pathways and assessing feasibility

Abstract

Breast cancer incidence starts to increase exponentially when women reach 30-39 years and it is the most common cause of death in women aged 35-50 years in the UK. In the majority of such cases, the women do not have a strong family history of breast cancer and have not been identified as being at increased risk of developing the disease. Identifying women aged 30--39 years at increased risk of developing breast cancer without a strong family history would allow them access to screening and preventive strategies that could facilitate earlier detection of breast cancer and reduce breast cancer mortality. In the period up to the beginning of this PhD, much of the research investigating the provision of personalised breast cancer risk estimates has been conducted within the context of implementing a risk-based breast cancer screening programme. Consequently, little was known regarding how a similar programme could be delivered to younger women without a strong family history of breast cancer outside of an organised screening programme. Therefore, this PhD aimed to inform the development of acceptable care pathways for the provision of personalised breast cancer risk assessment and where appropriate, screening or preventive strategies, to women aged 30-39 years without a strong family history. It did this by investigating the views of primary care providers and women as the intended deliverers and recipients respectively. A systematic review (Study One) was conducted synthesising the quantitative data on primary care providers' attitudes and routine behaviours in the context of breast cancer risk assessment and primary prevention. The findings of Study One informed the development of a qualitative study with primary care providers to explore their views on the development of a breast cancer risk assessment and primary prevention pathway for young women within primary care (Study Two). Study Three investigated women's views on, and requirements for, a breast cancer risk assessment service. This study resulted in two papers, one relating to optimising the delivery of risk assessment and one examining young women's beliefs about breast cancer risk and experiences of breast awareness. The planned methods and analyses for a study assessing the feasibility of offering breast cancer risk assessment to women aged 30-39 years without a strong family history of breast cancer is provided (Study Four) with a focus on acceptability to these women. Breast cancer risk assessment was considered acceptable in principle to eligible women providing that a risk management plan and support from healthcare professionals is available. A 'one-stop shop' delivery model that minimised the effort required to engage with breast cancer risk assessment was desired by women. However, women may not engage with breast cancer risk assessment because of their perception of breast cancer as an older woman's disease and reported disengagement with breast awareness. Our findings suggest that general practices are likely to accept an increased role in breast cancer risk assessment, but they have concerns about managing women identified as increased risk. How risk management services for women identified at increased risk will be provided and who will be responsible for delivering them remains a key issue to be resolved. Different delivery models should be evaluated with due consideration given to the views of healthcare personnel involved in delivery to inform healthcare system capacity requirements and the views of women to ensure equity of access.

Date of Award	1 Aug 2024
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Louise Gorman (Supervisor), Sacha Howell (Supervisor) & David French (Supervisor)