Priorities for breast cancer risk assessment in UK women under age 50: a survey and discrete choice experiment

Abstract

National guidelines recommend English women between 30 and 49 years with moderate/high risk of breast cancer (BC) be offered screening and prevention interventions. Identification  largely relies on family history-based criteria amongst women self-presenting in primary care. We aimed to understand the preference for different potential risk assessment strategies in this population. A cross-sectional survey including a discrete choice experiment. Risk assessments were defined using six attributes, including initiation strategy, eligibility for a full/detailed risk assessment, components of the risk assessment, including multifactorial risk assessment based on the BOADICEA/CanRisk model, and sensitivity. Coefficients from conditional logistic regression were used to estimate preference for different risk assessment approaches compared to current care. Participants (n = 893) preferred alternative approaches for risk assessments over current care, particularly where all eligible women were proactively invited and more above-average risk women were correctly identified. All but one of 21 risk assessment approaches was preferred, with the most favoured approaches having a probability of being preferred over current care >92%. Education level and ethnicity potentially impacted the strength of participant priorities. Offering multifactorial BC risk assessments to younger women in primary care, especially the most proactive and broad approaches, would be acceptable and preferred over current practice.