Acceptability of Automated Robotic Clinical Breast Examination: Survey Study

Background: In the United Kingdom, women are invited to attend screening mammography from 50 to 70 years of age.
However, 10% of invasive breast cancers occur in women 45 or younger. This represents an unmet need for young women.
Identifying a suitable screening modality for this population is challenging; mammography is insufficiently sensitive while
alternative diagnostic methods are invasive or costly. Robotic Clinical Breast Examination (R-CBE) - using soft robotic
technology and machine learning for fully automated clinical breast examination - is a theoretically promising screening
modality with early prototypes under development. Understanding the perspectives of potential users, and partnering with
patients in the design process from the outset, is essential for ensuring patient-centred design and implementation of this
technology.
Objective: This pilot study investigates the attitudes and perspectives of women towards the use of soft robotics and intelligent
systems in breast cancer screening. It aims to determine whether such technology is theoretically acceptable to potential users,
and to identify aspects of the technology and implementation system that are priorities for patients, allowing these to be
integrated into technology design.
Methods: We conducted a 30-minute online survey of 155 women in the United Kingdom. The survey consisted of 5 open-
ended questions and 17 closed questions. A brief overview of the proposed ARTEMIS device was provided to respondents.
Respondents were recruited through an online survey linked to the CRUK patient involvement opportunities page, People in
Health West of England e-mail lists, and other public research networks.
Results: Results showed enthusiasm for R-CBE with 92% of respondents indicating they would definitely or probably use R-
CBE. 83% would willingly be examined for up to 15 minutes. The most popular location for R-CBE was at a GP surgery,
whereas the most accepted method for receiving the results was an on-screen display (with an option to print information)
immediately after the examination. Thematic analysis of free text responses identified the following seven themes: a) Women
perceive that R-CBE has potential to address limitations in current screening services; b) R-CBE may facilitate increased user
choice and autonomy; c) ethical motivations for supporting R-CBE development; d) accuracy (and user’s perceptions of
accuracy) is essential; e) results management with clear communication is a priority for users; f) device usability is important,
and g) integration with health services is key.
Conclusions: There is enthusiasm for R-CBE among potential users, and a high concordance between user expectations and
technological feasibility. Early patient participation in the design process allowed the authors to identify key development
priorities for ensuring this new technology will meet the needs of users. Ongoing patient and public involvement at each stage of
development will be essential.