Today's blog is by Amelia Smit, who has recently completed a placement with PHG Foundation working on our personalised prevention in breast cancer project. Amelia is a PhD student in a Cancer Epidemiology and Prevention Research Group at the Sydney School of Public Health.
Breast cancer is preventable and a person’s risk of developing breast cancer can be managed at any age. Despite this, it continues to be a leading cause of death across the world. It is the most common cancer to affect women and, what is less appreciated, also affects a small number of men.
Encouraging breast cancer prevention forms one part of broader health promotion strategies, which strive to empower, support and enable individuals to take control of their health. Currently, health promotion for breast cancer aims to improve awareness about the disease, provide education on risk factors and nudge people towards more health positive behaviours such as limiting alcohol intake.
Most health promotion messages are targeted at the general population. This, despite recognition that generalised advice may be less effective than advice more tailored to individuals. But we could potentially further improve the beneficial impact of health promotion by using a more personalised approach.
We could use our knowledge about how breast cancer risk varies between people according to their behaviours, environments and biological characteristics (e.g. genetics) to personalise health promotion strategies. Tailoring health promotion might make the information more relevant to the context of people’s lives and may help enable them to achieve their health goals.
A role for digitally enabled wearable devices and apps in health promotion
Successful personalised approaches require tools for the collection of individual information and subsequent delivery of tailored messages. This is already beginning to happen - it’s likely that you know someone who wears a FitBit or tracks their daily steps using an app on their mobile. Could these devices or similar be used by health systems for the benefit of individuals? Some possible uses include:
- Collecting data: Today, screening advice for breast cancer is typically based on gender and age. But if the health system could collect reliable data about a person’s daily behaviours and environment, screening recommendations could be more targeted. Wearable devices could collect this information in order to estimate a person’s risk of breast cancer, either by a clinician or using AI. An app could deliver recommendations as to whether that person should seek breast cancer screening based on their personal risk.
- Enabling health-related behaviours: Suggestions to individuals on prevention behaviours are often one-size-fits-all. A wearable device could help identify a person’s health-related behaviours that need improvement, and target these behaviours via personalised feedback and educational information. This may be more helpful for supporting health-related behaviours compared to general advice.
- Supporting diversity: Differences in languages, cultures and health literacy are all factors that may influence the impact of health promotion efforts. Wearable devices and apps wont resolve the problem, but could help health promotion messages reach more people across a more diverse range of groups. An app could ask questions to assess individual health literacy and numeracy as well as social and cultural background, and the information could be tailored accordingly.
Just one piece of the health promotion puzzle
Today, wearable devices and apps are mainly used for tracking physical activity and are available as consumer items. There are very few apps and wearable devices that focus on supporting breast cancer prevention for people in the general population. Research and development of wearable devices that could help diagnose early signs of breast cancer is emerging but these technologies still require thorough examination. There has been only limited investigation into how wearable devices and apps might be integrated into health promotion.
Before health commissioners rush to buy up the latest apps however, there are many questions to be answered, not least, will the general population stand to benefit from breast cancer prevention strategies that are more personalised? How and why should we incorporate available digital technologies into health promotion and other healthcare pathways? In addition to data storage and analytics, what are the social and ethical considerations regarding personalised prevention and use of technology?
Health promotion not only aims strategies at individuals, but also at the systems that influence health, including the social, economic and environmental. Equipping people to adopt preventive behaviours and optimise their health can - and should - be approached throughout any of these systems. Digital technologies may well offer benefits for future health promotion to ameliorate systemic disadvantage.
Clearly wearables and apps could be a foundation on which to build better, more personalised health promotion strategies, but it will be important to understand their limitations. PHG Foundation is investigating these issues as part of Breast Cancer Stratification (B-Cast) and My Healthy Future.