Canadian Healthcare Organizations Are Not Ready for Risk-Based Breast Cancer Screening

Canada’s breast screening programs may soon undergo their most profound transformation in decades, but a new study suggests the organizations that would deliver this change are only half-prepared for it. A cross-sectional questionnaire study published in BMC Health Services Research has measured, with unusual precision, how ready Canadian healthcare organizations actually are to implement risk-stratified breast cancer screening, or RSBS, an approach that would replace today’s one-size-fits-all mammography schedule with screening intensity tailored to each woman’s individual risk of developing the disease. The verdict from 237 healthcare professionals and policymakers is sobering: organizations somewhat value the idea, but they are far less certain they can commit to it and actually deliver it.

The science behind RSBS is compelling enough that it has become one of the most discussed proposals in modern cancer prevention. Instead of inviting all women aged 40 to 74 for the same screening at the same intervals, risk-stratified screening would use information such as genetic markers, including variants in genes like BRCA1, family history, breast density, and other risk factors to sort women into categories. Women at elevated risk could be screened more frequently or with additional imaging, while women at lower risk might safely avoid some of the repeated mammograms that carry the burden of false positives, overdiagnosis, and unnecessary anxiety. The approach promises better detection where it matters most and less harm where screening adds little, a proposition that aligns squarely with the principles of precision medicine that have reshaped oncology over the past two decades.

But translating that promise into a functioning national program requires more than good science; it requires organizations capable of absorbing a complex operational change. The research team, led by Nareh Safieh Garabedian of the University of Cambridge’s Centre for Cancer Genetic Epidemiology together with Jacques Simard of Université Laval and Nora Pashayan, approached this problem through the lens of implementation science, the field that studies how evidence-based practices actually get adopted in real-world settings. Their central premise draws on a well-established concept: organizational readiness for change is a critical precursor of successful implementation. If the organizations delivering screening do not believe in the change and do not feel capable of executing it, even the best evidence will stall at the policy level.

To measure readiness, the team deployed a validated psychometric instrument known as the Organizational Readiness for Implementing Change scale, abbreviated ORIC. This tool comprises two subscales: change commitment, which captures how much organizational members value the change and are willing to invest in it, and change efficacy, which reflects their shared confidence that the organization can coordinate and execute the change successfully. The researchers also assessed change valence using Shea and colleagues’ change valence scale, a determinant of readiness that measures how worthwhile organizational members perceive the change to be. All items used five-point Likert scales ranging from 1, meaning disagree, to 5, meaning agree, allowing the team to quantify perceptions across a spectrum from rejection to enthusiastic endorsement.

The questionnaire reached healthcare professionals involved in delivering or administering breast screening programs across Canada, as well as policymakers, drawing participants from organizations spanning the full landscape of Canadian cancer screening, including provincial programs, professional associations of radiologists, genetic counsellors, family physicians in oncology, nursing regulators, and patient advocacy groups. Of the 338 participants who attempted the questionnaire, 237 fully completed it, a substantial sample for a study of this kind. The study received research ethics board approval from CHU de Québec-Université Laval and was conducted in accordance with the Declaration of Helsinki, with all participants providing informed consent and data collected anonymously.

The headline numbers reveal a striking gap between value and capacity. The median ORIC score was 3.50, with an interquartile range of 3.00 to 4.25, indicating that perceived readiness ranged from uncertain to somewhat ready. Change commitment scored a median of 3.50, change efficacy 3.40, and change valence 4.00, the highest of the four measures. Readiness levels showed no significant differences across interest-holder levels, meaning frontline clinicians, program administrators, and policymakers perceived readiness similarly, a finding that suggests the readiness deficit is systemic rather than confined to any single tier of the healthcare hierarchy.

The most technically revealing results came from the item-level analysis. A remarkable 87 percent of respondents agreed that RSBS aligned with their organizational values, confirming that the concept enjoys broad normative support across the Canadian healthcare community. Yet when the questions turned to organizational capability, confidence collapsed. Only 42 to 50 percent of respondents felt confident in their organizations’ management of politics or in their capacity to support staff through the transition. This dissociation between valence and efficacy is precisely the pattern that implementation scientists warn about: organizations can sincerely believe a change is worthwhile while simultaneously doubting their ability to navigate the political, structural, and human challenges of delivering it.

The statistical analysis also identified a powerful psychological lever. Agreement that RSBS makes sense was associated with higher perceived readiness and higher change valence, with all p-values at or below 0.002, indicating that these associations were unlikely to be due to chance. In practical terms, when organizational members understand the rationale for risk-stratified screening and find it intellectually coherent, their perception of the organization’s readiness rises along with their sense that the change is worthwhile. This finding suggests that communication and education about the scientific basis of RSBS are not peripheral concerns but central determinants of whether the approach will be adopted successfully.

The authors conclude that strengthening readiness would require visible leadership, positioning RSBS as an organizational priority, and enhanced capacity to manage politics, support staff, sustain momentum, and monitor progress. These are not vague aspirations; they map directly onto the specific capability gaps the questionnaire exposed. Visible leadership addresses the commitment deficit, while explicit political management and staff support address the efficacy gaps that only 42 to 50 percent of respondents trusted their organizations to handle. Sustaining momentum and monitoring progress speak to the longitudinal challenge of maintaining change efficacy through the years it would take to restructure screening programs around individual risk profiles rather than age-based invitations.

The study was conducted as part of the PERSPECTIVE I&I project, supported by the Government of Canada through Genome Canada, the Canadian Institutes of Health Research, Génome Québec, the Quebec Breast Cancer Foundation, the CHU de Québec Foundation, and the Ontario Research Fund, reflecting the multi-jurisdictional investment that risk-stratified screening has attracted in Canada. The findings highlight both an opportunity and a need: the opportunity to proactively build organizational readiness before implementation begins, rather than discovering readiness deficits after programs have launched, and the need to strengthen the empirical evidence on how readiness influences RSBS adoption. For a country whose screening programs have operated on essentially the same model for decades, the message is clear: the science of personalized screening is ready, but the organizations that would deliver it are still building the muscles they need. Closing that gap between belief and capability may determine whether Canadian women see risk-tailored screening become reality or remain a promising idea waiting for institutions to catch up.

Subject of Research: Assessing healthcare organizational readiness to implement risk-stratified breast cancer screening in Canada: a cross-sectional questionnaire study

Article Title: Assessing healthcare organizational readiness to implement risk-stratified breast cancer screening in Canada: a cross-sectional questionnaire study

Article References: Garabedian, N. S., Blackmore, K. M., Chiquette, J., Lambert-Côté, L., Lapointe, J., Lessard, J., Nabi, H., Omeranovic, A., Soucy, P., Turgeon, A., Walker, M., Chiarelli, A. M., Simard, J., & Pashayan, N. (2026). Assessing healthcare organizational readiness to implement risk-stratified breast cancer screening in Canada: a cross-sectional questionnaire study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15626-4

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15626-4

Keywords: Assessing, healthcare, organizational, readiness, implement, risk-stratified, breast, cancer, screening, Canada, cross-sectional, questionnaire