Views of health professionals on risk-based breast cancer screening and its implementation in the Spanish National Health System: A qualitative discussion group study

Background: With the aim of increasing benefits and decreasing harms, risk-based breast cancer screening has been proposed as an alternative to age-based screening. This study explores barriers and facilitators to implementing a risk-based breast cancer screening program from the perspective of health professionals, in the context of a National Health Service. Methods: Socio-constructivist qualitative research carried out in Catalonia (Spain), in the year 2019. Four discussion groups were conducted, with a total of 29 health professionals from primary care, breast cancer screening programs, hospital breast units, epidemiology units, and clinical specialties. A descriptive-interpretive thematic analysis was performed. Results: Identified barriers included resistance to reducing the number of screening exams for low-risk women; resistance to change for health professionals; difficulties in risk communication; lack of conclusive evidence of the benefits of risk-based screening; limited economic resources; and organizational transformation. Facilitators include benefits of risk-based strategies for high and low-risk women; women's active role in their health care; proximity of women and primary care professionals; experience of health professionals in other screening programs; and greater efficiency of a risk-based screening program. Organizational and administrative changes in the health system, commitment by policy makers, training of health professionals, and educational interventions addressed to the general population will be required. Conclusions: Despite the expressed difficulties, participants supported the implementation of risk-based screening. They highlighted its benefits, especially for women at high risk of breast cancer and those under 50 years of age, and assumed a greater efficiency of the risk-based program compared to the aged-based one. Future studies should assess the efficiency and feasibility of risk-based breast cancer screening for its transfer to clinical practice.MR PI17/00834: Personalized breast cancer screening: assessment of its feasibility and acceptability in the National Health System. Instituto de Salud Carlos III and cofunded by Fondo Europeo de Desarrollo Regional (FEDER) ‘Una manera de hacer Europa’ https://www.isciii.es MCL PI18/00773: Collaboration of healthcare professionals to include shared decision-making in the breast cancer screening program. Instituto de Salud Carlos III and cofunded by Fondo Europeo de Desarrollo Regional (FEDER) ‘Una manera de hacer Europa’ https://www.isciii.es CLV Santander Program scholarship 2020: predoctoral fellow at the University of Lleida MJH-L: European Regional Development Fund (ERDF). European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 713679 from the Universitat Rovira i Virgili (URV). The funders did not participate in the study design, data collection and analysis, decision to publish, or preparation of the manuscript