A multi-stakeholder qualitative study on implementing population-based risk-stratified breast cancer screening in Singapore

Abstract

Breast cancer screening is usually based on age. Risk-based screening (RBS) aims to tailor screening to individual risk. Most studies focus on women’s views. Less is known about the perspectives of healthcare professionals and other stakeholders, especially in Asia. This study explores stakeholder views on implementing RBS in Singapore. We conducted 31 semi-structured online interviews (~60 minutes) between January and June 2025. Stakeholders included clinical research coordinators, clinicians, medical technology professionals, health economists, and financial planners. We analyzed transcripts using a combination of artificial intelligence-assisted and researcher-led thematic analysis. We also used term frequency–inverse document frequency analysis and sentiment analysis. Here we show that stakeholders recognize the potential value of RBS but remain uncertain about its implementation. Different stakeholder groups use distinct language that reflects their priorities. We identify 45 subthemes and reach full thematic saturation by the 28th interview. Stakeholders report that outdated guidance and unclear procedures limit understanding. They recognize differences between genetic and non-genetic risk but identify gaps in risk communication and actionable interventions. Positive views focus on collaboration and system support. Negative views focus on cultural resistance, operational burden, affordability, and concerns about data use. Stakeholders highlight the need for stronger data systems, greater clinical capacity, better public awareness, and practical interventions that support uptake. RBS requires more groundwork before large-scale implementation. System readiness, strong clinical evidence, guideline endorsement, and policy support are needed. Success should be evaluated through clinical outcomes, implementation measures, cost-effectiveness, quality of life, and policy impact.