Introduction
cancer worry, breast cancers, anxiety, breast cancer
BREAST, BREAST CANCER
National screening programmes for breast cancer such as the National Health Service Breast Screening Programme (NHSBSP) aim to detect and treat breast cancers earlier and thereby reduce mortality [One innovation to improve the ratio of benefits to harms is to risk-stratify screening, whereby women with different levels of risk are offered different detection and prevention options [Before a service that offers risk-stratified screening could be implemented, it is important to establish whether risk-stratified screening would induce harms and if so, how they can be mitigated so as not to outweigh benefits [The PROCAS study found no evidence of major harm from receiving risk estimates. The women who received risk estimates reported slightly higher cancer worry scores, but lower general anxiety scores than comparison women awaiting results [This analysis had several limitations, however. First, in the PROCAS study, communication of risk estimates happened approximately three years after women provided their questionnaire data and consent, as the main purpose of that study was to validate risk prediction algorithms rather than assess a new screening service model [There are also potential benefits of risk-stratified screening including the receipt of personalised risk information promoting behaviour change that could reduce the risk of breast cancer. The best evidence to date on this point from the PROCAS study does not suggest this is likely, but, the evidence base has a number of limitations as previously articulated [The overall aim of the present research was therefore to establish whether providing women eligible for NHSBSP with BC-Predict increases potential harms (notably anxiety and cancer worry) and benefits (notably knowledge and intentions to attend future screening), at 3 months and 6 months post screening. Specific objectives were as follows, in line with a pre-specified research protocol:Are there differences in self-report measures of harms and benefits between women offered BC-Predict compared to women offered NHSBSP, controlling for baseline values?Are there differences in self-report measures of harms and benefits between women who accept BC-Predict compared to women who decline BC-Predict, controlling for baseline values?Are there differential changes in self-report measures of harms and benefits for the four groups of women provided with different risk estimates (i.e., high, moderate, average and below average) by BC-Predict?