Organizational challenges to equity in the delivery of services within a new personalized risk-based approach to breast cancer screening

Abstract

Emerging evidence opens new possibilities to improve current breast cancer mammography screening programs. One promising avenue is to tailor mammography screening according to individual risk. However, some factors could challenge the implementation of such approach, specifically its potential impact on the equitable delivery of services. This study aims to identify the barriers and facilitators to the equitable delivery of services within a future integration of a personalized approach in the Québec screening program. We then propose different means to address them. We conducted 16 semi-structured interviews with stakeholders with a role in the management, implementation or assessment of the Québec screening program. The barriers and facilitators identified by respondents were regrouped in two themes: 1) Reproduction of social inequities, and 2) Amplification of regional disparities in access to services. We consider that fostering inclusion through communication strategies and relying on electronic communication technologies could help in addressing these issues.

Keywords:

• breast cancer
• equity
• screening
• personalized medicine

ORCID

Emmanuelle Lévesque http://orcid.org/0000-0002-4618-6635

Bartha M. Knoppers http://orcid.org/0000-0001-7004-2722

Additional information

Funding

This study was conducted with the financial support of the Quebec Breast Cancer Foundation, the Government of Canada through Genome Canada and the Canadian Institutes of Health Research, and the Ministère de l’Économie, de l’Innovation et des Exportations du Québec through Genome Québec.