Key stakeholders' perspectives on implementation of risk-based population breast cancer screening in Australia - "We can either get on the bus or get under it".

Background: Risk-based breast cancer screening would be a dramatic shift from the current one-size-fits-all model to a tailored approach where screening modality and frequency is directed by individual risk. This project assesses what key stakeholders, defined as those holding managerial and decision-making roles within BreastScreen, consider the issues are with implementing a risk-based approach to screening.

Methods: A qualitative approach was undertaken, recruiting participants through professional networks with interviews guided by the Consolidated Framework of Implementation Research (CFIR). Participants were key stakeholders defined as those managing, overseeing and influencing Breast Screen throughout Australia. Data were deductively coded against a CFIR-informed codebook, followed by content analysis per CFIR domain.

Results: Twenty interviews were conducted with 21 participants. 144 initial codes consolidated into 17 final themes. Key stakeholders are supportive and optimistic about risk-based screening in principle; however several issues exist, including knowledge gaps precluding support of evidence-based implementation. Concerns about worsening inequities within screening, cost and communication with clients are major issues key stakeholders consider important to address in the planning and implementing a change to the program.

Conclusions: Key stakeholders in Australia were overwhelmingly enthusiastic about the benefits of a risk-based approach however there are concerns about risk assessment utility, cost and the potential risk to equity in the program. Systematic assessment of these concerns will be required to facilitate successful change to the well-established breast screening program in Australia should risk-stratification be undertaken.