| […] In order to introduce screening at the population level, a series of randomized clinical trials were carried out, it had to be shown over and over again that mammography is effective. To introduce personalized screening we are also going to need to provide convincing scientific evidence. And currently, what is the strong evidence to make a strong recommendation in favor of personalized screening over standard screening? Or instead of opportunistic screening? Or instead of not screening? At the moment I think, as far as I know, that the studies are underway, but there are no results. So, at this moment, it would be a barrier for me if I wanted to convince the people that I have around and they tell me: "hey, I already have a lot to do, why are you asking me to change?" (DG3P6) |
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Barrier: program burden may fall on primary care
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| One thing is the colon screening where you collect the sample and the other thing is the genomic test. The genomic test cannot be performed at home by the user, so they need assistance. Overloading primary care with more, there are 50,000 women and I don’t know what percentage will decide to not participate, but if we have 20% who will say no, we will have 40,000. (DG2P3) |
| […] is a burden for primary care, probably unbearable from the current situation … If you are the primary care physician and you have to invite women, you need time or infrastructure … I understand […] (DG4P5) |
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Barrier: lack of time and job instability of primary care professionals
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| And, I’m talking from primary care … There’s a lot of nursing rotation …, monthly contracts and such, and now I’m going into policy a little bit. So what then? […] I cover several consultations … And our nurses are changing practically every month. (GD1P1) |
| […] First, all these doctors have to be trained, and that’s not easy. I say this because I’ve tried it several times with breast topics and I haven’t quite gotten it, […]. And then there’s medical staff rotations, meaning you have the trained medical staff and over the holidays there are staff changes … (DGP2P1) |
| And it is also the lack of time, in primary care, what I see as the biggest problem, personally of course, is time. (DG2P2) |
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Barrier: high costs of measuring risks
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| The problem is that all, all women from the age of 40 onwards have to have a mammogram, the clinical history, the genomic study, plus the visit of the doctor or nurse who has to explain all these risks to you, economically I do not know if the health system can currently assume this for all women of 40 years of age. (DG1P3) |
| […] There would also be a resource that has not been considered which is the laboratory. There will be hundreds of SNPs to evaluate. (DG3P4) |
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Facilitator: increased accuracy in risk quantification
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| … the more the screening program is adapted to the probability of having cancer, the better it works. Therefore, you would remove women with very low probability and improve the precision for women with very high probability. I think conceptually, yes. (DG3P4) |
| What happens is that perhaps this more accurate estimate of risk is not all of a sudden. I think doing this would be a huge step in the accuracy of risk, which is not being done anywhere in the world. (DG4P4) |
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Facilitator: higher efficiency of risk-based screening
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| I think screening with mammography has reached its ceiling […] And there is a need for change […] it will no longer be considered beneficial because […] it is already being demonstrated […]. In addition, we have tools that allow us to better estimate risk. […] And you give value to the test and also to the risk estimate. This is very important for adherence! (DG3P1) |
| […] 30% of breast cancers we treat in Lleida are in women less than 50 years old and 30% are over 70. Therefore, we have 60% of the population outside the screening program. The impression we have is that there are patients, people, women, who do not need to do a biennial screening program and instead, there are women who are outside the age range who will surely need it. And I think it’s a very, very interesting program. (DG2P1) |
