Implementing Risk-Stratified Breast Screening in England: An Agenda Setting Meeting

SIMPLE SUMMARY: A risk-stratified approach to breast cancer screening has gained international interest as a mechanism to better balance the benefits, harms and costs of screening programmes. The aim of our agenda setting meeting was to identify key uncertainties to resolve in order to implement a risk-stratified breast screening programme within England. Findings from a 5-year programme of research assessing the feasibility of such an approach in England were presented before individual discussion groups and an open plenary session regarding what preparation needs to take place. Key findings highlight the need to further develop risk modelling to ensure equity of access to breast cancer risk assessment and ensure a risk-stratified programme is cost-effective. Other issues highlighted related to capacity and capability of the health services to offer an integrated risk assessment pathway that is accessible. Attendees identified ways in which risk-stratification could be implemented to minimise inequity of access to screening. ABSTRACT: It is now possible to accurately assess breast cancer risk at routine NHS Breast Screening Programme (NHSBSP) appointments, provide risk feedback and offer risk management strategies to women at higher risk. These strategies include National Institute for Health and Care Excellence (NICE) approved additional breast screening and risk-reducing medication. However, the NHSBSP invites nearly all women three-yearly, regardless of risk. In March 2022, a one-day agenda setting meeting took place in Manchester to discuss the feasibility and desirability of implementation of risk-stratified screening in the NHSBSP. Fifty-eight individuals participated (38 face-to-face, 20 virtual) with relevant expertise from academic, clinical and/or policy-making perspectives. Key findings were presented from the PROCAS2 NIHR programme grant regarding feasibility of risk-stratified screening in the NHSBSP. Participants discussed key uncertainties in seven groups, followed by a plenary session. Discussions were audio-recorded and thematically analysed to produce descriptive themes. Five themes were developed: (i) risk and health economic modelling; (ii) health inequalities and communication with women; (iii); extending screening intervals for low-risk women; (iv) integration with existing NHSBSP; and (v) potential new service models. Most attendees expected some form of risk-stratified breast screening to be implemented in England and collectively identified key issues to be resolved to facilitate this.