1
|
Lim ZL, Giam F, Wong RYX, Liow JJK, McCrickerd K, Li J. Do women with a history of breast cancer recommend risk-based breast cancer screening? An in-depth interview study. Front Psychol 2025; 16:1414099. [PMID: 40330299 PMCID: PMC12052940 DOI: 10.3389/fpsyg.2025.1414099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 03/28/2025] [Indexed: 05/08/2025] Open
Abstract
Objectives Personalizing screening recommendations could enhance efficiency, support timely detection, and optimize resource use. This study explores women's perceptions of the facilitators and barriers to current screening guidelines and the implementation of risk-based screening (RBS) for breast cancer in Singapore. Methods Individual semi-structured interviews were conducted with 11 women aged 21 and above with a history of breast cancer. Data coding and thematic analysis were guided by the Health Belief Model (HBM). Results Five themes were identified and mapped to the Health Belief Model (HBM): (1) Knowledge and beliefs, (2) Access to mammography screening, (3) Social influences, (4) Healthcare delivery, and (5) Needs and preferences for RBS implementation. Key barriers to screening adherence included low perceived susceptibility, cost concerns, and accessibility issues. Factors that could improve adherence included social influences promoting breast health awareness, reminders from trusted healthcare professionals (HCP), and confidence in affording screening and treatment. Participants were generally receptive to RBS and valued personalized recommendations, but concerns were raised about risk prediction accuracy, insurance implications, and potential negative reactions to risk results. Conclusion This study identifies challenges and enablers for enhancing breast screening in Singapore, based on the experiences of breast cancer survivors. Participants supported RBS for routine screening. Successful RBS implementation requires improved health literacy, HCP engagement, and accessible healthcare. Women's acceptance will rely on research to refine prediction accuracy and communication of risk results.
Collapse
Affiliation(s)
- Zi Lin Lim
- Laboratory of Women’s Health and Genetics, Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Freda Giam
- Human Development, Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Renee Ying Xuan Wong
- Laboratory of Women’s Health and Genetics, Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Jonathan Jun Kit Liow
- Laboratory of Women’s Health and Genetics, Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Keri McCrickerd
- Human Development, Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jingmei Li
- Laboratory of Women’s Health and Genetics, Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- National Cancer Singapore, SingHealth, Singapore, Singapore
| |
Collapse
|
2
|
Higgins I, Kleinig P, Le DT, Londema J, Shephard B, Siow EMQ, Sohal E, Kumar S. Facilitators and Barriers to Cancer Screening Participation Across Southeastic Asia: A Scoping Review. Psychooncology 2025; 34:e70139. [PMID: 40181418 PMCID: PMC11969030 DOI: 10.1002/pon.70139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 02/06/2025] [Accepted: 03/20/2025] [Indexed: 04/05/2025]
Abstract
OBJECTIVE As the prevalence of cancer cases in Southeast Asia (SEA) increases, understanding facilitators and barriers to participation in and uptake of cancer screening is important. However, to date, no review has been undertaken on this topic. This review aimed to address this knowledge gap. METHODS The search was conducted across academic databases and grey literature sources. Two reviewers independently screened the results, followed by data extraction. Social cognitive therapy was used as part of narrative synthesis of the data. RESULTS Of the 735 studies, 26 were included. Barriers and facilitators were grouped into headings of personal, environmental, societal, and behavioural domains. The commonly reported barriers to participation in cancer screening included poor knowledge, emotional factors, belief of low personal susceptibility, lack of time, misperceptions, cost, inconvenience, social influence, and lack of skills required. The facilitators were education, greater self-perceived risk, reassurance, past medical history, reduced cost and improved access to healthcare, social supports, religious beliefs, and routine health check-ups. CONCLUSIONS A multitude of barriers, and some facilitators, to participation in cancer screening were reported in the literature. This complexity highlights the importance of a multifaceted and nuanced strategy in promoting cancer screening in SEA countries.
Collapse
Affiliation(s)
- Isabelle Higgins
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
| | - Paige Kleinig
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
| | - Duy Toan Le
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
| | - Jade Londema
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
| | - Benn Shephard
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
| | - Emily Mei Qiong Siow
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
| | - Ekam Sohal
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
| | - Saravana Kumar
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
| |
Collapse
|
3
|
Wang Y, Ho PJ, Mou L, Li J. Women's preferences for testing to predict breast cancer risk - a discrete choice experiment. J Transl Med 2025; 23:96. [PMID: 39838430 PMCID: PMC11753052 DOI: 10.1186/s12967-025-06119-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 01/08/2025] [Indexed: 01/23/2025] Open
Abstract
BACKGROUND Risk-based breast cancer screening offers a more targeted and potentially cost-effective approach in cancer detection compared to age-based screening. This study aims to understand women's preferences and willingness for undergoing risk assessment tests. METHODS A discrete choice experiment (DCE) was conducted. Six attributes were selected to construct the DCE questionnaire: one-time cost of the test, methods for reducing late-stage breast cancer, annual breast cancer screening expenses, insurance coverage for early-stage breast cancer, family risk correlation, and risk communication methods. Women aged between 21 and 59 were recruited from Singapore. Latent class analysis was performed. RESULTS Three hundred twenty-eight women were included in the analysis and classified into two classes: test supporters and non-supporters. Both classes prioritised test costs and screening costs. Among non-cost attributes, the potential to reduce late-stage breast cancer diagnosis was the most influential factor. Insurance coverage increased willingness to undergo testing. Risk communication methods were not significant in influencing the decision of undergoing tests. Non-supporters were less inclined to take the test if family risk correlation was high. Younger women, married women, full-time employees, and those with a history of breast disease were more likely to be supporters. Women with a family history of breast cancer were more likely to be non-supporters. CONCLUSIONS Financial incentives play a notable role in increasing the uptake of risk-prediction tests. However, the programme's success depends on understanding and addressing the diverse preferences of women. While cost considerations ranked highly, additional strategies are needed to engage groups that are hesitant, particularly those with a high family risk correlation.
Collapse
Affiliation(s)
- Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Republic of Singapore.
| | - Peh Joo Ho
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Republic of Singapore
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, 138672, Republic of Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228, Republic of Singapore
| | - Langming Mou
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Republic of Singapore
| | - Jingmei Li
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, 138672, Republic of Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228, Republic of Singapore
- National Cancer Centre Singapore, Singapore, 168583, Republic of Singapore
| |
Collapse
|
4
|
Muyskens K, Ballantyne A, Savulescu J, Nasir HU, Muralidharan A. The Permissibility of Biased AI in a Biased World: An Ethical Analysis of AI for Screening and Referrals for Diabetic Retinopathy in Singapore. Asian Bioeth Rev 2025; 17:167-185. [PMID: 39896078 PMCID: PMC11785882 DOI: 10.1007/s41649-024-00315-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 07/01/2024] [Accepted: 07/28/2024] [Indexed: 02/04/2025] Open
Abstract
A significant and important ethical tension in resource allocation and public health ethics is between utility and equity. We explore this tension between utility and equity in the context of health AI through an examination of a diagnostic AI screening tool for diabetic retinopathy developed by a team of researchers at Duke-NUS in Singapore. While this tool was found to be effective, it was not equally effective across every ethnic group in Singapore, being less effective for the minority Malay population than for the Chinese majority. We discuss the problematic normative nature of bias in health AI and explore the ways in which bias can interact with various forms of social inequalities. From there, we examine the specifics of the diabetic retinopathy case and weigh up specific trade-offs between utility and equity. Ultimately, we conclude that it is ethically permissible to prioritise utility over equity where certain criteria hold. Given that any medical AI is more likely than not to have lingering bias due to bias in the training data that may reflect other social inequalities, we argue that it is permissible to implement an AI tool with residual bias where: (1) its introduction reduces the influence of biases (even if overall inequality is worsened), and/or (2) where the utility gained is significant enough and shared across groups (even if unevenly).
Collapse
Affiliation(s)
- Kathryn Muyskens
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Angela Ballantyne
- Department of Primary Health Care and General Practice, University of Otago, Dunedin, New Zealand
| | - Julian Savulescu
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- University of Oxford, Oxford, UK
| | - Harisan Unais Nasir
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anantharaman Muralidharan
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
5
|
Laza C, Niño de Guzmán E, Gea M, Plazas M, Posso M, Rué M, Castells X, Román M. "For and against" factors influencing participation in personalized breast cancer screening programs: a qualitative systematic review until March 2022. Arch Public Health 2024; 82:23. [PMID: 38389068 PMCID: PMC10882761 DOI: 10.1186/s13690-024-01248-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Personalized breast cancer screening is a novel strategy that estimates individual risk based on age, breast density, family history of breast cancer, personal history of benign breast lesions, and polygenic risk. Its goal is to propose personalized early detection recommendations for women in the target population based on their individual risk. Our aim was to synthesize the factors that influence women's decision to participate in personalized breast cancer screening, from the perspective of women and health care professionals. METHODS Systematic review of qualitative evidence on factors influencing participation in personalized Breast Cancer Screening. We searched in Medline, Web of science, Scopus, EMBASE, CINAHL and PsycINFO for qualitative and mixed methods studies published up to March 2022. Two reviewers conducted study selection and extracted main findings. We applied the best-fit framework synthesis and adopted the Multilevel influences on the cancer care continuum model for analysis. After organizing initial codes into the seven levels of the selected model, we followed thematic analysis and developed descriptive and analytical themes. We assessed the methodological quality with the Critical Appraisal Skills Program tool. RESULTS We identified 18 studies published between 2017 and 2022, conducted in developed countries. Nine studies were focused on women (n = 478) and in four studies women had participated in a personalized screening program. Nine studies focused in health care professionals (n = 162) and were conducted in primary care and breast cancer screening program settings. Factors influencing women's decision to participate relate to the women themselves, the type of program (personalized breast cancer screening) and perspective of health care professionals. Factors that determined women participation included persistent beliefs and insufficient knowledge about breast cancer and personalized screening, variable psychological reactions, and negative attitudes towards breast cancer risk estimates. Other factors against participation were insufficient health care professionals knowledge on genetics related to breast cancer and personalized screening process. The factors that were favourable included the women's perceived benefits for themselves and the positive impact on health systems. CONCLUSION We identified the main factors influencing women's decisions to participate in personalized breast cancer screening. Factors related to women, were the most relevant negative factors. A future implementation requires improving health literacy for women and health care professionals, as well as raising awareness of the strategy in society.
Collapse
Affiliation(s)
- Celmira Laza
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Biomedical Research Institute of Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, Spain
| | - Ena Niño de Guzmán
- Cancer Prevention and Control Program, Institut Català d' Oncologia, Barcelona, Spain
| | - Montserrat Gea
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Biomedical Research Institute of Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, Spain
| | - Merideidy Plazas
- Cochrane Associated Center- University Foundation of Health Sciences, Bogotá, Colombia
| | - Margarita Posso
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain
| | - Montserrat Rué
- Biomedical Research Institute of Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, Spain
- Basic Medical Sciences, University of Lleida, Lleida, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain.
| |
Collapse
|
6
|
Ahmed H, Mushahid H. Overcoming challenges to breast cancer screening among Muslim women: addressing barriers to early detection and treatment: A correspondence. Cancer Causes Control 2023; 34:505-507. [PMID: 37022632 DOI: 10.1007/s10552-023-01693-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023]
Abstract
Breast cancer is the second leading cause of cancer-related deaths and is the most common type of cancer diagnosed in women. In an attempt to decrease its mortality, screening guidelines recommend mammograms, breast self-examinations, and breast clinical examinations for women above the age of 40. Compliance to these guidelines have been found to be significantly low in Muslim women which has been linked to their perceptions of religious guidelines regarding modesty and fatalism. In order to overcome these barriers and increase screening rates among Muslim women, faith-based intervention has been proven to be effective as it incorporates the use of religious leaders and allows the concerns of women to be addressed directly.
Collapse
Affiliation(s)
- Huda Ahmed
- Dow Medical College, Dow University of Health Sciences, Baba-E-Urdu Road, Karachi, Pakistan.
| | - Hasan Mushahid
- Dow Medical College, Dow University of Health Sciences, Baba-E-Urdu Road, Karachi, Pakistan
| |
Collapse
|