Anetta Bolejko

Aim To explore perceptions of annual surveillance with magnetic resonance imaging and perceptions of care during the examination among women with a hereditary risk of breast cancer. Design Phenomenography. Methods Fourteen face‐to‐face interviews using a semi‐structured interview guide were conducted among women undergoing surveillance in the southern region of Sweden. A seven‐step phenomenographic analysis with investigator triangulation was performed. Results ‘Considering own risk of developing breast cancer’, ‘Entrusting oneself to surveillance’ and ‘Living in a cycle’ represented descriptive categories of perceptions. Family narratives introduced comprehension of own risk of breast cancer, followed by appraisal of own benefits of participating in surveillance. Entrusting oneself to surveillance included handing over management of diagnostic examinations and dealing with practical issues and diverse emotions related to surveillance. Planning life based around surveillance, struggling with fluctuating emotions, also between the examinations and questioning own identity implied the perception of living in a cycle. Conclusion Surveillance for hereditary breast cancer implies living in a cycle of dealing with fluctuating emotions and planning life based around surveillance. Comprehension of one's own risk for breast cancer arises from awareness in the family. Women value the surveillance programme and trust the healthcare system. Implication for the Profession and Patient Care Knowledge of women's perceptions of the surveillance programme and care is vital for supporting women in their decision‐making on attendance and providing person‐centred care during surveillance. Impact A gap in explorative studies from the perspective of the individual woman in the context of surveillance for breast cancer and care in magnetic resonance imaging in surveillance was addressed. ‘Considering own risk of developing breast cancer’, ‘Entrusting oneself to surveillance’ and ‘Living in a cycle’ represented women's perceptions of surveillance and care. The study results have implications for person‐centred care among women in the surveillance programme. Patient or Public Contribution No patient or public contribution.

Objective To determine the feasibility of a digitally automated population‐based programme for organised prostate cancer testing (OPT) in Southern Sweden. Patients and Methods A pilot project for a regional OPT was conducted between September 2020 and February 2021, inviting 999 randomly selected men aged 50, 56, or 62 years. Risk stratification was based on prostate‐specific antigen (PSA) level, PSA density (PSAD), and bi‐parametric prostate magnetic resonance imaging (MRI). Men with a PSA level of 3–99 ng/mL had an MRI, and men with elevated PSA level (≥3 ng/mL) had a urological check‐up, including a digital rectal examination and transrectal ultrasonography (TRUS). Indications for targeted and/or systematic transrectal prostate biopsies were suspicious lesions on MRI (Prostate Imaging‐Reporting and Data System [PI‐RADS] 4–5) and/or PSAD > 0.15 ng/mL/mL. Additional indications for prostate biopsies were palpable tumours, PSA ratio < 0.1, or cancer suspicion on TRUS. Patient selection, mail correspondence, data collection, and algorithm processing were performed by an automated digital management system. Feasibility is reported descriptively. Results A total of 418 men had a PSA test (42%), with increasing participation rates by age (50 years, 38%; 56 years, 44%; and 62 years, 45%). Among these, 35 men (8%) had elevated PSA levels (≥3 ng/mL: one of 139, aged 50 years; 10/143, aged 56 years; and 24/146, aged 62 years). On MRI, 16 men (48%) had a negative scan (PI‐RADS < 3), seven men (21%) had PI‐RADS 3, nine men (27%) had PI‐RADS 4, and one man (3%) had PI‐RADS 5. All men with PI‐RADS 4 or 5 underwent prostate biopsies, as well as two men with PI‐RADS 3 due to PSAD > 0.15 ng/mL/mL or a suspicious finding on TRUS. Prostate cancer was diagnosed in 10 men. Six men underwent active treatment, whereas four men were assigned to active surveillance. Conclusion Our OPT model is feasible from an operational point of view, but due to the limited scale of this study no conclusions can be made regarding the efficacy of the diagnostic model or outcome.