Community health service center is the main gatekeeper for breast cancer screening, while its efficacy of screening is difficult to guarantee for the re-striction of screening process by various factors.
To analyze the focus issue of breast cancer screening program in the real world and explore corresponding solutions.
A mixed-methods convergent design was used to collect quantitative and quali-tative data. In the quantitative study, typical sampling method was used to select one community health service center in each of the four districts of Tianjin as the investigation institution from April 2021 to November 2022, accidental sampling method was used to select age-eligible women within 3 km of the four institutions as resident survey respondents, so as to explore the issues existing in the on-site operation of breast cancer screening. In the qualitative study, 9 residents, 12 physicians participating in the screening and 4 leaders were selected through purposive sampling from June to November 2022 for semi-structured in-terviews. The grounded theory was used to analyze the interview content, and the grounded theory framework of the focus issues of breast cancer screening was plotted. Combined with literature and typical investigation data, a mixed methods study was conducted to determine the focus issues of breast cancer screening.
The quantitative study showed that in the advocacy work, the promotion method is traditional, the awareness rate and participation rate of residents was 46.3% (143/309) and 32.4% (100/309) , respectively; in the screening work, the institutions invested different human and material resources, and the average waiting time of screening residents accounted for 62.2% (40.5/65.1) of the total time; in the follow-up and referral work, the invested human and material resources were little, the mammography referral compliance of residents was 29.9% (59/197) . The qualitative study showed that a total of 38 comprehensive open codes were formed in the interview and converged into 10 axial codes and 3 core codes, including advocacy organization, screening organization, follow-up and referral. The mixed methods study showed that 3 focus issues were identified in final, including how to improve residents' participation rate, how to ensure adequate human and material resources in screening institutions, and how to improve residents' mammography referral compliance.
The efficacy of breast cancer screening is influenced by advocacy organization, screening organization, follow-up and referral. It is necessary to rationally allocate resources to ensure adequate human and material resources for screening institutions; innovate promotion methods, expand coverage of promotion and improve residents' health literacy, participation rates and mammography referral compliance, to ensure the substantial progress of breast cancer screening and provide reference for opti-mizing the efficacy of breast cancer screening.
Due to many barriers, it is difficult for primary medical institutions to ensure substantial achievements in breast cancer screening. So it is particularly important to establish a system for scientifically and effectively assessing the capacities of primary care institutions in conducting breast cancer screening.
To construct a system for assessing the capacities of primary care institutions for conducting breast cancer screening.
From September to October 2022, through literature review and group discussion, we developed an item pool of the initial version of Breast Cancer Screening Capacity Assessment System for Primary Care Institutions (BCSCASPCI) . Then we conducted an online Delphi survey between November and December 2022 using a self-developed questionnaire with a purposive sample of 21 experts for understanding their views regarding the initial version of BCSCASPCI, and the response coefficient, authority coefficient, and the Kendall's W of the survey were calculated. Finally, based on the results of the survey and a group discussion, the final version of the BCSCASPCI was determined. The Analytic Hierarchy Process was used to determine the weight coefficients of its indicators and to examine the logical consistency of indicators.
All the experts returned effective questionnaires, achieving a response rate of 100.0%, and the authority coefficient was 0.812, and the Kendall's W was 0.209 (P<0.001) . The final version of the BCSCASPCI consists of 3 primary indicators (structure, process, and outcome) , 10 secondary indicators, and 56 tertiary indicators. The weight coefficients of the 3 primary indicators were 0.310 8, 0.195 8 and 0.493 4, respectively. The consistency ratios of indicators at each level were <0.100.
Our BCSCASPCI has proven to be highly authoritative and scientific, and is expected to provide guidance and reference for studies related to breast cancer screening capacity assessment. But the applicability and application effects of the system still needs further verification.
The low coverage rate of breast cancer screening has affected the prevention and control effect of breast cancer in China. Factors related to the screening coverage rate include multiple aspects of the screening implementation process.
Based on the implementation process of breast cancer screening in China, this study aims to simulate the changes in the breast cancer screening coverage rate before and after the implement optimization measures to provide suggestions for optimizing the breast cancer screening coverage rate in China.
From July to September 2022, we systematically searched the journal literature on female breast cancer screening in four databases, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Data to collate and summarize the relevant influencing factors of women's screening behaviors. Collating and analysing the breast cancer screening pathways and systematic subjects of breast cancer screening in China based on the official documents of the relevant governmental websites on breast cancer screening. Based on China's breast cancer screening pathways, screening subjects and screening behavioral correlates, we constructed the causality diagram of the breast cancer screening coverage and the stock flow diagram of the system dynamics of the breast cancer screening coverage. Simulating the effects of some optimisation strategies for breast cancer screening coverage in China, 2010-2040.
The model simulates previous screening strategies and policy resource environment. Breast cancer screening coverage gradually increased to 40% between 2010 and 2013. From 2013 to 2040, it fluctuates between 40% and 45%, showing a trend of slow decline at first and then a slow rise. Policy intervention scenarios, based on the improved population's screening intention and screening accessibility strategy, respectively simulated five kinds of optimization measures of breast cancer screening coverage rate from 2024. The five measures are as follows: (1) focusing on publicity and education, (2) standardizing the quality of screening services, (3) controlling per-case screening costs, (4) doubling the number of special breast cancer screening slots, (5) standardizing the quality of screening services and controlling per-case screening costs. The measure of focusing on publicity and education will increase rapidly coverage rate during 2024-2030 to 60.38%, then increase slowly to 66.04% during 2031-2040. The screening coverage rate will rapidly increase to 60.27% before 2029, after standardizing the quality of screening services. Then it will slowly increase to 66.04% from 2030 to 2040. After controlling per-case screening costs, the screening coverage rate will increase from 46.95% to 54.17% in 2024-2026. Then the screening coverage rate up to 58.95% in 2027-2040. Compared with no optimization measures during 2024-2040, doubling the number of special breast cancer screening slots will only increase the screening coverage rate by 1%-2%. The screening coverage rate in 2024-2040 increased from 46.95% to 86.79%, after standardizing the quality of screening services and controlling per-case screening costs.
Breast cancer screening coverage is projected to fluctuate from 41.7% to 46.0% in China from 2024 to 2040. Improving screening intention or accessibility can improve screening coverage, but the two optimization measures have their own upper limits. Meanwhile, in the Chinese population, the optimization measures to improve screening intention are better than the optimization measures to improve screening accessibility. Combined optimization measures to improve population's screening intention and screening accessibility can break through the upper limit of their respective promotion and have a better effect on improving screening coverage.
