Exploring Women's Perceptions of Traditional Mammography and the Concept of AI-Driven Thermography to Improve the Breast Cancer Screening Journey: Mixed Methods Study.

Background: Breast cancer is the most common cancer among women and a leading cause of mortality in Europe. Early detection through screening reduces mortality, yet participation in mammography-based programs remains suboptimal due to discomfort, radiation exposure, and accessibility issues. Thermography, particularly when driven by artificial intelligence (AI), is being explored as a noninvasive, radiation-free alternative. However, its acceptance, reliability, and impact on the screening experience remain underexplored.

Objective: This study aimed to explore women's perceptions of AI-enhanced thermography (ThermoBreast) as an alternative to mammography. It aims to identify barriers and motivators related to breast cancer screening and assess how ThermoBreast might improve the screening experience.

Methods: A mixed methods approach was adopted, combining an online survey with follow-up focus groups. The survey captured women's knowledge, attitudes, and experiences related to breast cancer screening and was used to recruit participants for qualitative exploration. After the focus groups, the survey was relaunched to include additional respondents. Quantitative data were analyzed using SPSS (IBM Corp), and qualitative data were analyzed in MAXQDA (VERBI software). Findings from both strands were synthesized to redesign the breast cancer screening journey.

Results: A total of 228 valid survey responses were analyzed. Of 228, 154 women (68%) had previously undergone mammography, while 74 (32%) had not. The most reported motivators were belief in prevention (69/154, 45%), invitations from screening programs (68/154, 44%), and doctor recommendations (45/154, 29%). Among nonscreeners, key barriers included no recommendation from a doctor (39/74, 53%), absence of symptoms (27/74, 36%), and perceived age ineligibility (17/74, 23%). Pain, long appointment waits, and fear of radiation were also mentioned. In total, 18 women (mean age 45.3 years, SD 13.6) participated in 6 focus groups. Participants emphasized the importance of respectful and empathetic interactions with medical staff, clear communication, and emotional comfort-factors they perceived as more influential than the screening technology itself. ThermoBreast was positively received for being contactless, radiation-free, and potentially more comfortable. Participants described it as "less traumatic," "easier," and "a game changer." However, concerns were raised regarding its novelty, lack of clinical validation, and data privacy. Some participants expressed the need for human oversight in AI-supported procedures and requested more information on how AI is used. Based on these insights, an updated screening journey was developed, highlighting improvements in preparation, appointment booking, privacy, and communication of results.

Conclusions: While AI-driven thermography shows promise as a noninvasive, user-friendly alternative to mammography, its adoption depends on trust, clinical validation, and effective communication from health care professionals. It may expand screening access for populations underserved by mammography, such as younger and immobile women, but does not eliminate all participation barriers. Long-term studies and direct comparisons between mammography and thermography are needed to assess diagnostic accuracy, patient experience, and their impact on screening participation and outcomes.