Every year in England, over 400,000 women are referred to secondary care breast services via the breast cancer suspected two-week-wait (2WW) pathway. Of the women who attend the breast clinic via the current 2WW pathway, 6% are diagnosed with cancer; the remaining 94% are discharged from the service.

Although the women who are discharged may be reassured that they do not currently have breast cancer, they are not given any information about their personal risk of developing the disease in the future. This is a significant missed opportunity. Conducting multifactorial risk assessment during this existing touch-point would identify a large number of women who could benefit from interventions to reduce/manage their risk. Due to their recent breast cancer referral, these women may also be more likely to engage.

Dr Stephanie Archer and her team in the Department of Psychology will use an Early Detection and Diagnosis Primer Award to develop a pathway integrating multifactorial Risk Assessment to enable Risk Stratification within secondary care Breast Cancer services.

The team will conduct a rapid ethnography in two secondary care breast cancer services to explore and better understand the context and culture within the breast cancer suspected 2WW/FDS pathway. In addition, they will conduct approximately 40 one-to-one interviews with key stakeholders (e.g. surgeons, nurses, radiologists, pathway co-ordinators, service managers) to explore when and how multifactorial risk assessment might be conducted, identify routinely collected clinical data that might be available to inform the risk assessment, and discover what the challenges might be to implementing a new pathway. Following this, they will conduct two co-design workshops with patients, healthcare professionals and non-clinical staff from both clinical sites. During the workshops the team will present the learnings from the ethnography/interviews and use this information to co-design a new breast cancer suspected 2WW/FDS pathway that incorporates multifactorial risk assessment. The final pathway and programme will be shared with the staff and patients from the secondary care breast cancer services in a series of engagement events, and seek feedback on the prospective acceptability and feasibility of implementation.

How the results will be used?
The co-designed breast cancer suspected 2WW/FDS pathway that incorporates multifactorial risk assessment will form the basis of future funding applications (CRUK/NIHR) to explore its efficacy and effectiveness. The new pathway, when fully implemented into secondary care breast services, will enable risk stratification of a large group of women during a routine existing touch point, maximising opportunities for the early detection and diagnosis of breast cancer.