---
title: "Acceptability of breast cancer risk assessment for women 30–49 from six under-served groups"
id: "plos-one-16-acceptability-of-breast-cancer-risk-assessment-for-women-aged-30-49-views-of"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-16-acceptability-of-breast-cancer-risk-assessment-for-women-aged-30-49-views-of"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356263"
published_at: "2026-08-17T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Acceptability of breast cancer risk assessment for women 30–49 from six under-served groups
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-16-acceptability-of-breast-cancer-risk-assessment-for-women-aged-30-49-views-of
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356263)
- **Published At:** 2026-08-17T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This qualitative study explored acceptability of a proactive **breast cancer risk assessment** service for women aged 30–49, focusing on six under-served groups: South Asian (Muslim) women, Black African and Black Caribbean women, Roma women, women in low socioeconomic neighbourhoods, women with learning disabilities and/or autism, and women with long-term anxiety and/or depression. - Fifty-two women took part across 10 focus groups and one interview, with data analysed using a thematic framework approach. - Overall, participants were enthusiastic about offering risk assessment to younger women and saw potential benefits for early detection and prevention. - Common facilitators identified were delivery by female healthcare staff, locally based services, a straightforward process, strong assurances about data privacy, and community events to raise awareness. - Major concerns included the potential emotional impact of receiving risk information, indicating a need for clear communication and tailored psychological support. - Among ethnic minority groups, breast cancer was often perceived as taboo, which complicated discussion and accurate sharing of family history information for risk calculation. - Women with learning disabilities, those living in deprived areas, and those with mental health conditions described overlapping barriers such as low health literacy, inaccessible invitations, logistical challenges, and competing life pressures. - The authors conclude that to reduce inequalities in early detection, **risk assessment services** must be culturally sensitive, streamlined, community-supported, and designed to address both shared and group-specific barriers.
## Clinical Analysis & Structured Key Points
Acceptability of breast cancer risk assessment for women aged 30–49: Views of women from six under-served groups | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures Figures Abstract Inequalities in breast screening uptake and cancer outcomes persist among under-served women. To reduce disparities, it is essential to understand women’s views when developing proactive early detection and prevention services. This study explored the acceptability of introducing a breast cancer risk assessment service for women aged 30–49, offering early screening and/or risk-reducing medication to those at moderate or high-risk. We conducted extensive engagement with six communities of typically under-served women, selected to represent diverse and overlapping sources of disadvantage: (1) South Asian Muslim women, (2) Black women, (3) Roma women, (4) women in low socio-economic neighbourhoods, (5) women with learning disabilities and/or autism, and (6) women with long-term anxiety and/or depression. Fifty-two women participated in 10 focus groups and one interview. Data were analysed using a thematic framework approach. All groups were enthusiastic about a breast cancer risk assessment for young women. Across groups, female healthcare staff, local delivery, a straightforward process, and assurances about data privacy were valued to reduce barriers and promote engagement. Women also supported local events to promote risk assessment and breast cancer awareness. Concerns about the emotional impact of risk information highlighted the need for clear communication and tailored support across groups. Among ethnic minority women, breast cancer was often seen as taboo, limiting discussion and complicating the sharing of family history. These findings highlight that under-served women face both shared and unique challenges. To enhance uptake and reduce longstanding early detection inequalities, risk assessment services should be culturally sensitive, streamlined, and supported by community-based awareness initiatives. Citation: Woof VG, Valasaki M, Stutzin Donoso F, McWilliams L, Morley H, Usher-Smith J, et al. (2026) Acceptability of breast cancer risk assessment for women aged 30–49: Views of women from six under-served groups. PLoS One 21(8): e0356263. https://doi.org/10.1371/journal.pone.0356263 Editor: Taiwo Opeyemi Aremu, Touro University California College of Pharmacy, UNITED STATES OF AMERICA Received: January 7, 2026; Accepted: July 31, 2026; Published: August 17, 2026 Copyright: © 2026 Woof et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The minimal data set is available at figshare via https://doi.org/10.48420/32743704 . Funding: This study was funded by the Cancer Research UK International Early Detection of Cancer Alliance (ACED) (EDDAMC-2023/100004) and the Manchester Academic Health Science Centre (MAHSC): Cancer Domain. DPF, LMW and HM are supported by the National Institute for Health Research Manchester Biomedical Research Centre (NIHR203308). DF is a NIHR Senior Investigator (NIHR305827). LMW is supported by a Cancer Research UK Career Development Fellowship (RCCCDF-May25/100006). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Introduction Globally, the incidence of breast cancer in pre-menopausal women is increasing [ 1 , 2 ]. In the UK, approximately 7% of all breast cancer cases occur in women under age 40 years [ 3 ]. Compared to cases diagnosed in women over age 50, breast cancers in younger women tend to be more aggressive, with a ten-year survival rate of 70% for those aged 40 and below, compared to 87% for women aged 50 and above [ 4 ]. Given this, there is increasing interest in approaches to identify pre-menopausal women at increased risk of developing the disease to support prevention and improve survival through early detection and treatment [ 5 ]. In the UK, the NHS Breast Screening Programme (NHSBSP) offers screening every three years to women aged 50–71. However, in line with UK National Institute for Health and Care Excellence (NICE) guidelines, younger women who self-present to primary care with a strong family history of breast cancer are offered a referral to family history risk and prevention clinics to assess their eligibility for early breast screening and/or preventative medication [ 6 ]. Nevertheless, around 65% of breast cancers diagnosed in younger women occur in those without a family history [ 4 , 7 ]. Given this, to better identify younger women at increased risk, the feasibility of personalised breast cancer risk assessment is being investigated [ 5 ]. Risk prediction models such as the Tyrer-Cuzick [ 8 ] and BOADICEA [ 9 , 10 ] can estimate an individual’s likelihood of developing breast cancer by incorporating factors such as family history, hormonal and reproductive factors, polygenic risk scores, and health behaviours. This area has progressed as far as initial feasibility trials offering risk assessments to women aged 30–49, laying the groundwork for broader implementation [ 11 – 13 ]. However, addressing potential inequalities of uptake has been identified as a key issue that needs to be resolved before any service is implemented [ 5 , 14 ]. In the NHSBSP, uptake of mammography is consistently lower among women facing social, cultural, or health-related disadvantages [ 15 – 17 ]. For example, women living in areas of social deprivation may encounter barriers such as low health literacy, financial constraints, competing life pressures, and logistical challenges associated with the location of screening sites [ 16 , 18 , 19 ]. Similar challenges are also observed among women with learning disabilities, where low health literacy and inaccessible invitation methods further hinder participation [ 20 , 21 ]. Women from minoritised communities, such as South Asian women, and those from Gypsy, Irish Traveller, and Roma communities, may additionally experience disadvantages related to stigma, fear, limited knowledge of screening programmes, and language barriers that restrict access [ 22 – 24 ]. Women with mental health conditions also experience reduced screening uptake, often linked to difficulties accessing primary care, diagnostic overshadowing, and socioeconomic disadvantage [ 25 ]. Across these groups, overlapping and intersecting barriers contribute to persistent inequalities in breast screening participation, which could contribute to delayed diagnoses, poorer health outcomes, and preventable mortality. Qualitative research to date suggests that young women generally find the implementation of breast cancer risk assessment acceptable, provided the service is easily accessible, well-resourced, and supported by appropriate healthcare expertise [ 26 ]. However, while some perspectives from women from under-served backgrounds have been included, most participants in this study were White-British and from middle to high income areas. Similarly, trials testing the feasibility of introducing risk assessment at population screening level (aged 50–70) have struggled to engage women from underserved groups, with participants disproportionately identifying as White-British and from medium to high income areas [ 27 ]. Therefore, these gaps highlight an urgent need to engage more meaningfully with women from under-served communities before implementing any new health initiative, to ensure services are equitable and responsive to diverse needs. This study aimed to explore the perceived acceptability of breast cancer risk assessment among women aged 30–49, with a particular focus on those from under-served communities and those experiencing barriers to accessing healthcare services, contributing to health inequalities. This study also aimed to explore where these women’s experiences of healthcare inequality overlap and where they diverge to inform the development of a service which addresses significant areas of marginalisation. This research forms part of a funded multi-study project designed to develop and evaluate an inclusive risk assessment service for young women. Methods Design A cross-sectional qualitative design was used, employing focus groups and one-to-one semi-structured interviews. Data collection took place either in-person and online via Zoom. Participants and recruitment Women aged between 30–49 without a history of breast cancer from the following communities and backgrounds were approached to participate: women from South Asian (Muslim) backgrounds, women from Black African and Black Caribbean backgrounds, women from the Roma community, women from low socio-economic neighbourhoods (based on postcode data), women with self-reported learning disabilities and/or autism and, women with self-reported long-term anxiety and/or depression (long-term defined as a diagnosis of 1-year or longer). These groups were identified based on available evidence and stakeholder consultations suggesting these communities of women face significant barriers to breast screening and are underrepresented in breast cancer risk assessment research. They were selected to capture a range of disadvantage, ensuring that the major reasons for lack of uptake could be included. The choice to include different groups of women was endorsed through Patient and Public Involvement and Engagement (PPIE) conducted prior to submission of the grant, although participants did not suggest the selected groups themselves. In addition, the groups partly reflect communities with whom the researchers have previously worked with given our interest as researchers on reducing health inequalities. The researchers also acknowledge the presence of intersectionality within these groups, recognising that women may belong to multiple groups depending on their identities and experiences. Recruitment strategies for each group were developed in collaboration with the study’s PPIE contributors who represented their communities, as well as professionals working in roles that support them. These contributors advised on the relevance of the research question and topic area and guided the research team on effective ways to approach women to participate. Acting on this guidance, the research team approached a range of charities/community organisations in Greater Manchester and the Cambridgeshire area. VGW and MV initiated contact both in-person and via email to assess interest in supporting recruitment. The researchers then met or had an email exchange with charity/community organisation representatives to discuss the study’s relevance to their communities and design tailored communication strategies for recruitment. In some cases, posters in community spaces and information shared via mailing lists proved sufficient. In others, particularly for women whose first language was not English, or for women with learning disabilities and/or autism, trusted community leaders and support workers discussed the research directly with potential participants. This allowed women to hear about the study from someone familiar in a trusted setting. To minimise any risk of coercion, women were encouraged to contact the lead researchers directly, or, if they preferred, to have a trusted contact from the charity/community organisation reach out on their behalf. Recruitment proved challenging for the long-term anxiety and/or depression group, with only 4 of the 18 charities contacted sharing the study information within their networks. Consequently, low participant numbers led researchers to draw on professional networks to recruit additional participants. Following the advertisement of the study, women who were interested in participating and who met the eligibility criteria registered their interest either through staff at the charity/community organisation or directly with the lead researchers (VGW & MV) via telephone or email. Eligible women who met two or more criteria and were eligible to participate in one or more of the focus groups were asked to indicate their preferred focus group for participation. For example, women from low socio-economic neighbours who also identified as South Asian (Muslim) were asked which focus group they would prefer to participate in. Women who preferred or who were unable to participate in a focus group were offered a one-to-one interview either in-person or online via Zoom. Recruitment for the study ran from March to April 2025. Procedure Focus groups were selected as the preferred method of data collection because they provide an environment that fosters dynamic discussion and exploration of differing viewpoints, allowing for a comprehensive examination of the topic [ 28 ]. Focus groups took place either online via Zoom or in-person in community spaces known and local to women. At each focus group, two female researchers were present so that one acted as the moderator, while the other took notes of the discussion to feedback to the group. Before the discussion began, participants provided written or verbal informed consent, including for data collection to be audio-recorded, and completed optional demographic questions ( S1 File ). Capacity for consent for women with learning disabilities and/or autism was determined in collaboration with support workers and charity staff, and the researcher took time to explain the consent process thoroughly and discuss any questions or concerns women had. They were then reminded of the discussion topics, given an overview of the group’s ground rules, and provided with time to ask questions. To facilitate a comfortable atmosphere, icebreaker activities were conducted, allowing both participants and researchers to get to know each other. Once this was completed, the audio recorder was turned on, and the focus group began. A semi-structured topic guide was used flexibly throughout ( S1 File ). The topic guide was initially developed by the research team and informed by the Theoretical Framework of Acceptability (TFA); a tool used to evaluate the acceptability of healthcare interventions [ 29 ]. The topic guide was then further refined in collaboration with the study’s PPIE volunteers. The topic guide underwent several revisions before the final version was agreed upon. Topics included, how women discuss breast cancer and risk within their communities, their thoughts on the offer of a breast cancer risk assessment, potential barriers to accessing the assessment, as well as their views on the assessment process, including the provision of information and communication. Questions also explored views on breast cancer early detection and prevention management. The primary topic guide was adapted slightly for those with learning disabilities and/or autism and the Roma community group, following feedback from PPIE contributors, support workers and charity/community organisation staff ( S1 File ). These modifications were made to enhance clarity and ensure cultural appropriateness. Breaks were provided in all focus groups when required. During this time the audio recorder was paused. For South Asian (Muslim) and Roma women, many of whom did not speak English as their first language, focus groups were conducted in Bengali and Romanian. Interpreters received the topic guide in advance to familiarise themselves with the subject matter and the questions to be discussed. VGW met with the interpreters prior to the focus groups to review the subject matter and clarify any terminology that required further explanation into either language. During these focus groups, the researcher addressed the women directly in English, while the interpreter translated and provided English translation to the researcher in the third person. With advice from the Roma community contact, a considerable amount of time was also spent raising awareness about the signs and symptoms of breast cancer, as well as risk factors during relevant points in the focus groups. This was done on the advice of the Roma community contact who disclosed that many of the women taking part had little to know knowledge about breast cancer and some time building awareness would help to contextualise risk assessment for the women in order for them to answer the topic guide questions. For the two focus groups held with women with learning disabilities and/or autism, participants were encouraged to bring a carer or support worker to assist them. To accommodate the needs of these women, more frequent breaks were incorporated, and in some instances, carers or support workers rephrased the questions to support the women in providing their answers. For some questions traffic light cards were used to gauge opinion and as prompts to explore reasons behind the colours chosen. As with the Roma community, time was also spent to raise awareness about breast cancer symptoms and risk factors to help contextualise risk assessment for those with limited knowledge about breast cancer. For one participant who was unable to attend the focus group with women with anxiety and/or depression, a one-to-one semi-structured interview was conducted by MV via Zoom. The same consenting procedures and primary topic guide were used. At the end of each focus group and interview, women were provided with a debrief sheet which detailed more information about the study, as well as useful resources should women have had any concerns about breast cancer. Women were also provided information leaflets on the signs and symptoms of breast cancer. These leaflets were available in multiple languages and easy read format. All women were also compensated for their time. All data were transcribed verbatim by an external transcription agency, which were checked by VGW for accuracy against the original audio recording and amended where needed. Identifiable information was anonymised and each participant allocated a pseudonym. Ethical approval This research was approved by the University of Manchester Research Ethics Committee 1 (UREC1; Ref: 2024-21249-38554). All participants provide written consent. Analysis Following data collection, the research team decided that data from each of the six groups of women would be analysed together. While these communities are diverse, they do share common experiences of marginalisation and inequalities in healthcare access. Analysing experiences collectively meant the research team were able to examine to what extent women shared views on introducing a breast cancer risk assessment for young women, as well as the unique differences and challenges women face within each group. Data were analysed in NVivo12 using thematic analysis, managed using the framework approach [ 30 ]. Primary data analysis was conducted by VGW and refined by MV, FSD and DPF. Analysis began with familiarisation, with VGW listening to audio recordings and reading transcripts of the focus groups and interview. Coding was both inductive and deductive, with the initial framework considering the domains of the TFA [ 29 ] but not being used deductively. Four transcripts were initially coded by VGW and an initial coding framework was developed. This framework was then checked and refined by MV and FSD before the final working framework was agreed upon. This framework was then applied to the remaining transcripts. Framework categories were arranging into distinct matrices using the ‘framework’ function in NVivo12 and then ex
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