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PLoS One. 2018 Jun 1;13(6):e0197772. doi: 10.1371/journal.pone.0197772. eCollection 2018.

Women's decision-making regarding risk-stratified breast cancer screening and prevention from the perspective of international healthcare professionals.

Author information

Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom.
Genomic Medicine, Division of Evolution and Genomic Sciences, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
The Christie NHS Foundation Trust, Withington, Manchester, United Kingdom.
Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet & Theme Cancer, Karolinska University Hospital, Huddinge, Sweden.
Dutch Expert Centre for Screening, Nijmegen, The Netherlands.



Increased knowledge of breast cancer risk factors may enable a paradigm shift from one-size-fits-all breast cancer screening to screening and subsequent prevention guided by a woman's individual risk of breast cancer. Professionals will play a key role in informing women about this new personalised screening and prevention programme. Therefore, it is essential to explore professionals' views of the acceptability of this new programme, since this may affect shared decision-making.


Professionals from three European countries (the Netherlands, United Kingdom, and Sweden) participated in digital concept mapping, a systematic mixed methods approach used to explore complex multidimensional constructs.


Across the three countries, professionals prioritised the following five themes which may impact decision-making from the perspective of eligible women: (1) Anxiety/worry; (2) Proactive approach; (3) Reassurance; (4) Lack of knowledge; and (5) Organisation of risk assessment and feedback. Furthermore, Dutch and British professionals expressed concerns regarding the acceptability of a heterogeneous screening policy, suggesting women will question their risk feedback and assigned pathway of care. Swedish professionals emphasised the potential impact of the programme on family relations.


The perspectives of Dutch, British, and Swedish professionals of women's decision-making regarding personalised breast cancer screening and prevention generally appear in line with women's own views of acceptability as previously reported. This will facilitate shared decision-making. However, concerns regarding potential consequences of this new programme for screening outcomes and organisation need to be addressed, since this may affect how professionals communicate the programme to eligible women.

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