Patient views about early diagnosis and prevention of breast cancer

Problem

Breast cancer is the most frequent cancer among women in the UK. Early detection through the NHS Breast Screening Programme using mammograms reduces the number of deaths from breast cancer by about 1,300 a year in the UK. Researchers at the University of Nottingham are developing a blood test which can detect the first signs of cancer up to five years before a patient suffers any symptoms. The test looks for antibodies produced by the patient in response to cancer. The blood test provides opportunities for early detection through more frequent mammograms for those with positive tests and for prevention through the use of certain medications e.g. tamoxifen or anastrozole, which can reduce the risk of developing breast cancer by up to 50%. The purpose of this study is to explore the views of the patients and GPs on facilitators and barriers to early diagnosis of breast cancer using an autoantibody blood test and chemoprevention for those with positive tests.

Approach

Semi-structured interviews with 30 women who are at variable risk of developing breast cancer; 15 women aged 40-59 years with above population risk of breast cancer attending the Familial Cancer Service at the Royal Derby Hospital and 15 women aged 41-80 years registered with participating general practices from Nottinghamshire and Derbyshire. Interviews were analyzed using framework analysis using NVivo software. Participants also completed a brief Patient Questionnaire, covering demographic characteristics, brief information on risk factors for breast cancer, perception of breast cancer risk and cancer worry

Findings

This study found that facilitators for the use of a blood test for the early detection of breast cancer include belief that early diagnosis saves lives, ease of access, convenience and availability of rapid test results. The barriers include worry about test results and needle phobia. Facilitators for considering preventive medication include reducing the risk of breast cancer, having a higher risk of breast cancer, caring responsibilities, available information and support in weighing up pros and cons of medication, and monitoring of serious side effects. Barriers for considering preventive medication are side effects, interaction with other medications and impact on quality of life.

Consequences

These findings enhance understanding of patients’ views on the use of a blood test for early diagnosis of breast cancer and prevention of breast cancer. The barriers and facilitators identified will help clinicians provide better information and advice and help patients make informed decisions about early detection and prevention of breast cancer. Study findings will be used to inform the design of a feasibility study for a randomized controlled trial to evaluate the effectiveness of the blood test.