Discussion
cancer worry, anxiety, breast cancer
ADVERSE EFFECTS, RECRUITMENT, BREAST CANCER
The present research is the first to our knowledge to report the feasibility and impact of real time breast cancer risk feedback based on mammographic density and standard risks on a population basis. The present research has found that it is feasible to set up risk estimation including automatic measures of mammographic density in several NHSBSP sites and provide risk feedback in a timely manner. Uptake rates to the study overall were generally low, and with lower BC-Predict uptake amongst lower SES (socioeconomic status) women. However, BC-Predict uptake rates were highly sensitive to changes in recruitment strategies (Table We have shown that it is feasible to provide risk feedback within a timeframe of 6–8 weeks from a woman undergoing a planned mammographic screen, despite major disruptions during the COVID-19 pandemic. There was clearly a ‘learning’ curve with Phase 2 recruitment from the Greater Manchester sites having very high return rates within 8 weeks (97.5% Table Uptake of the offer of risk estimation in BC-Predict (While overall uptake of risk appointments was also lower than expected with only just over 40% of those at high risk taking up an appointment, the uptake of BCPM amongst attendees was exceptionally high at 77.5%. This is markedly higher than the average 10–11% uptake in our FHRPC utilising the same clinicians [We have shown separately that in both questionnaire and qualitative nested sub-studies that there is no evidence of adverse effects on anxiety beyond transient cancer worry [There are some limitations to the present research. The study was not randomised and was dramatically impacted by the COVID-19 pandemic with uptake of the study and of risk appointments in those identified at moderate or high risk almost certainly affected. As such, generalisability of the results may need to be reassessed after the results from two large randomised trials [In conclusion, we have shown that breast cancer risk stratification can be done as part of routine NHSBSP delivery and supports the uptake of preventive medicines for women at high risk of breast cancer. For uptake, a simple letter invitation does not work and real time risk assessment is feasible if it does not include SNPs. Ideally, all women at moderate and high risk should have at least telephone feedback to further improve uptake of preventive medication. There is a need to consider how to increase uptake especially amongst lower SES and ethnic minority women, to avoid exacerbating inequalities. The present study provides important information on likely uptake rates for risk estimation, risk consultations and preventive options that are necessary to inform subsequent economic analyses of the healthcare costs and patient consequences (benefits and harms) in BC-Predict and of introducing risk stratification into the NHSBSP.