Structural equation modeling of factors influencing women's attitudes, comfort and willingness toward risk-stratified breast cancer screening.

Risk-stratified breast cancer screening has been proposed as an alternative to age-based screening programs, though its implementation may face challenges and requires support from stakeholders, particularly women. This study used structural equation modeling (SEM) to identify personal factors influencing women's attitudes, comfort level, and willingness towards risk-stratified screening. Factors analyzed included sociodemographic variables, general health, breast cancer risk perception, screening, and genetic testing history. Three models were tested to assess the direct and indirect effects of statistically significant factors. None of the outcomes were significantly associated with women's perceived health or history of genetic testing (all p > 0.05). A history of mammography was found to mediate the relationships between age, perceived risk, and personal breast cancer history with the outcomes. Income also mediated the relationships between education, employment, marital status, and the outcomes. A history of mammography and higher income were significantly associated with more favorable attitudes (β_mammo = 0.157; β_income = 0.098), greater comfort (β_mammo = 0.425; β_income = 0.134), and higher willingness (β_mammo = 0.471; β_income = 0.198) towards risk-stratified screening. In contrast, non-white ethnicity and older age were linked to less favorable attitudes (β_ethnicity =  - 0.117; β_age =  - 0.071), lower comfort (β_ethnicity =  - 0.104; β_age =  - 0.269), and decreased willingness (β_ethnicity =  - 0.142; β_age =  - 0.295). This study identified key factors influencing the acceptability of risk-stratified breast cancer screening that could be targeted to facilitate its implementation.