JMIR Publications

ABSTRACT

Background:

Breast cancer is the most common cancer among women and a leading cause of mortality in Europe. Early detection through screening reduces mortality, yet participation in mammography-based programmes remains suboptimal due to discomfort, radiation exposure, and accessibility issues. Thermography, particularly when enhanced with artificial intelligence (AI), is being explored as a non-invasive, radiation-free alternative. However, its acceptance, reliability, and impact on the screening experience remain underexplored.

Objective:

This study investigates women’s perceptions of AI-driven thermography as a breast cancer screening method. It examines barriers and motivators influencing mammography participation and explores the feasibility of ThermoBreast (AI-driven thermography) as a patient-centred alternative. Additionally, participant insights informed an updated breast cancer screening journey aimed at improving patient experience and increasing participation.

Methods:

This mixed-methods study was conducted in four phases. An initial online survey (n=101) assessed awareness, facilitators and barriers to mammography while recruiting focus group participants. A second phase included an expert focus group (n=7) to validate the study approach. The third phase involved five focus groups with 11 women who had undergone breast cancer screening, exploring perceptions of thermography and screening experiences. Finally, a second online survey (n=127) gathered further quantitative insights.

Results:

Focus group discussions highlighted that, beyond screening technology, factors such as interaction with medical staff, clear communication and a comfortable clinical environment significantly influenced participation. AI-driven thermography was valued for its non-invasiveness and absence of radiation but raised concerns about reliability, accessibility and data privacy. Some participants emphasised that their treatment during screening was more important than the technology used. Survey results showed that 68% (154/228) had undergone mammography, while 32% (74/228) had not. Screeners were motivated by prevention beliefs, screening invitations and doctor recommendations, while non-screeners cited the absence of symptoms, lack of physician advice and age restrictions. Key barriers included pain, waiting times and radiation concerns. Based on participant feedback, an updated breast cancer screening journey was developed to enhance pre-screening explanation, provide flexible booking options, improve clinical environments and ensure structured result communication.

Conclusions:

While AI-driven thermography shows promise as an alternative, its adoption depends on trust, clinical validation, and improved communication from healthcare professionals. It could expand screening access for younger and immobile women but does not address all participation barriers. As doctors play a crucial role in screening uptake, greater professional engagement in patient education is needed. Future research should focus on making screening programmes more inclusive, particularly for underrepresented groups such as lower-educated individuals, disadvantaged socioeconomic populations, men, and younger women. Additionally, more long-term studies and direct comparisons between mammography and thermography are needed to fully understand differences in screening experiences and their impact on participation and outcomes.