br Contents lists available at ScienceDirect br The Breast br

Contents lists available at ScienceDirect
The Breast
Original article
Consumer and clinician perspectives on personalising breast cancer prevention information
a Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia
b Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
c Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED) and Lipo3000 Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Sydney, Australia
d The Greater Green Triangle Clinical School, Deakin University School of Medicine, Warrnambool, Australia
e Department of General Practice, The University of Melbourne, Melbourne, Australia
f The Breast Service, Royal Melbourne and Royal Women's Hospital, Melbourne, Australia
g Department of Surgery, The University of Melbourne, Melbourne, Australia
h Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
i Department of Medicine, The University of Melbourne, Melbourne, Australia
j Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
Article history:
Received in revised form
Available online 7 November 2018
Keywords:
Breast cancer prevention
Risk management
Online risk assessment
Focus groups
Clinician perspectives
Consumer perspectives
Background: Personalised prevention of breast cancer has focused on women at very high risk, yet most breast cancers occur in women at average, or moderately increased risk ( moderate risk).
Objectives: To determine; 1) interest of women at moderate risk (consumers) in personalised infor-mation about breast cancer risk; 2) familial cancer clinicians' (FCCs) perspective on managing women at moderate risk, and; 3) both consumers' and FCCs reactions to iPrevent, a personalised breast cancer risk assessment and risk management decision support tool.
Methods: Seven focus groups on breast cancer risk were conducted with 49 participants; 27 consumers and 22 FCCs. Data were analysed thematically.
Results: Consumers reported some misconceptions, low trust in primary care practitioners for breast cancer prevention advice and frustration that they often lacked tailored advice about breast cancer risk. They expressed interest in receiving personalised risk information using iPrevent. FCCs reported an inadequate workforce to advise women at moderate risk and reacted positively to the potential of iPrevent to assist.
Conclusions: While highlighting a potential role for iPrevent, several outstanding issues remain. For personalised prevention of breast cancer to extend beyond women at high risk, we must harness women's interest in receiving tailored information about breast cancer prevention and identify a workforce willing to advise women.
1. Background
Despite the optimism around the possibilities of personalised prevention of cancer [1,2], and of breast cancer (BC) prevention in particular [3e5], so far, in Australia, the opportunities for person-alised prevention are almost exclusively for women at high risk of
* Corresponding author. Centre for Health Equity, Melbourne School of Popula-tion and Global Health The University of Melbourne, Australia. E-mail address: [email protected] (L.A. Keogh).
cancer due to family history or a genetic predisposition [6]. Cancer Australia defines three risk categories, based on family history, for Australian women: 1) at or slightly above average risk (chance is 1 in 11 to 1 in 8); 2) moderately increased risk (chance is between 1 in 8 and 1 in 4) and; 3) potentially high risk (chance is between 1 in 4 and 1 in 2). Cancer Australia state that more than 99% of women are either at or slightly above average risk, or have a moderately increased risk of breast cancer ( moderate risk) [7], and most breast cancers occur in this group of women. Therefore, the greatest cancer-control gains can be made with appropriately targeted