Psychological impact of risk-stratified screening as part of the NHS Breast Screening Programme: multi-site non-randomised comparison of BC-Predict versus usual screening (NCT04359420)

BACKGROUND: Adding risk stratification to standard screening via the NHS Breast Screening Programme (NHSBSP) allows women at higher risk to be offered additional prevention and screening options but may introduce harms such as increased cancer worry. This study assessed whether there were differences in self-reported harms and benefits between women offered risk stratification (BC-Predict) versus standard NHSBSP, controlling for baseline values. METHODS: As part of PROCAS2 (NCT04359420), 5901 women were offered standard NHSBSP or BC-Predict at invitation. Women who took up BC-Predict received 10-year risk estimates: high (≥8%), above average/moderate (5–7.99%), average (2–4.99%) or below average/low (<2%). A subset of 662 women completed questionnaires at baseline, 3 months (n=511) and 6 months (n=473). RESULTS: State anxiety and cancer worry scores were low, with no differences between women offered BC-Predict versus NHSBSP. Women offered BC-Predict and informed they were at higher risk reported higher risk perceptions and cancer worry than other women, but without reaching clinical levels. CONCLUSIONS: Concerns that risk-stratified screening will produce harm due to increases in general anxiety or cancer worry are unfounded, even for women informed that they are at high risk.

David P. French, Lorna McWilliams, Sarah Bowers, Victoria G. Woof, Fiona Harrison, Helen Ruane, Alice Hendy, D. Gareth Evans