Acceptability of breast cancer risk assessment amongst general population women aged 30-39 years: a qualitative study

Background: Breast cancer rates are increasing globally among premenopausal women, who often face aggressive subtypes with poorer outcomes compared to postmenopausal women. In the UK, current guidelines for risk assessment among women under age 50 years focus on family history or genetic predisposition, a strategy that fails to identify most women that go on to develop breast cancer. The Breast CANcer Risk Assessment in Younger women (BCAN-RAY) study is evaluating the feasibility and acceptability of a novel risk assessment strategy for women aged 30–39 years, without a strong family history, incorporating a risk factor questionnaire, polygenic risk score, and breast density assessment to identify those at increased risk and support early screening and preventive health measures. Objectives: This study aimed to investigate the acceptability of the BCAN-RAY approach to assessing risk by exploring women’s views of the invitation, risk assessment and feedback processes used, to identify any changes required. Design: A cross-sectional qualitative design was used. Methods: Twenty-two women from the BCAN-RAY study identified as being either at population average (n=11) or increased risk (n=11) of developing breast cancer completed semi-structured interviews shortly after receiving risk feedback. Data were analysed thematically. Results: Participants generally found the BCAN-RAY approach acceptable, with no evidence of significant anxiety during or after participation. Positive experiences were largely attributed to personalised staff interactions and the availability of tailored opportunities to manage risk. However, some participants reported confusion regarding risk information provided, e.g. struggling with technical language. Practical barriers, including logistical challenges and limitations of existing referral pathways, were also identified. Conclusion: Breast cancer risk assessment among younger women was generally acceptable with results allowing participants to be proactive about their health. Issues related to risk communication, training of staff who will conduct risk assessment, and streamlining the delivery of risk assessment need to be considered for routine implementation.