Examining barriers and facilitators to implementation of evidence-based genetic riskstratified breast cancer screening in primary care

Yue Guan ^1* Haley Barge ¹ Cam Escoffery ¹ Michele Cellai ² Susana Alfonso ² Theodore Johnson II ²

• ¹ Emory University, Atlanta, United States
• ² School of Medicine, Emory University, Atlanta, Georgia, United States

Introduction: Despite strong evidence supporting family cancer history screening as a tool for riskstratified cancer screening, implementation challenges remain. Most efforts often concentrate solely on the high-risk pathway rather than encompassing the entire patient population. This study aims to characterize primary care provider perspectives on implementing genetic-informed, riskstratified mammography screening guidelines.Methods: Semi-structured interviews were conducted with 14 providers and five practice leaders across two Georgia healthcare systems between November 2020 and May 2021. Interviews assessed barriers and facilitators at patient, provider, and system levels using the CFIR framework.Thematic analysis was conducted using MaxQDA, and Fishbone analysis was applied to summarize the results.Results: Barriers and facilitators differed between high-and low-risk pathways. High-risk pathway barriers included limited provider knowledge and unclear referral protocols, while facilitators included established provider-genetic professional relationships and effective EHR systems. For low-risk pathway, barriers centered on provider acceptance, guideline inconsistency, and risk communication challenges.Effective implementation of risk-stratified breast cancer screening requires tailored strategies to address pathway-specific barriers. Integrating ongoing education, clinical decision support, and workflow alignment may enhance program adoption.