Acceptability of breast cancer risk assessment for women aged 30-49: Views of women from six under-served groups.

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.