Randomized trial of a web-based personalized breast cancer risk communication and decision support tool on clinical prevention outcomes

Authors: Wernli KJ, Knerr S, Li T, Leppig K, Ehrlich K, Farrell D, Gao H, Bowles EJA, Graham AL, Luta G, Mandelblatt JS, Schwartz MD, O’Neill SC

Category: Behavioral Science & Health Communication
Conference Year: 2020

Abstract Body:
Purpose: We developed a web-based intervention, which incorporates personalized breast cancer risk, values clarification, and patient activation to clinical care, to support communication and decision-making about breast cancer mitigation strategies. We compared clinical outcomes in women who received intervention to usual care. Methods: We randomized 995 women aged 40-69 years to intervention (n=492) or usual care (n=503). Women were members of Kaiser Permanente Washington with a recent normal screening mammogram and a calculated risk of >1.67% based on the Breast Cancer Surveillance Consortium 5-year breast cancer risk model, which include breast density as a risk factor. Primary clinical outcomes were chemoprevention prescriptions and breast MRI by 12 months after baseline interview. Additional outcomes were self- reported distress, clinician conversations, and mammography maintenance. We calculated unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression with generalized estimating equations (GEE) to account for clustering. Differences in distress were calculated with 95% CIs using analysis of variance (ANOVA) with GEE. Results: Baseline demographic and clinical characteristics were similar between the two arms. While women in the intervention arm reported increased communication with their clinician about chemoprevention (OR=3.9, 95% CI 2.3-6.5), overall uptake was <1% with no differences across study arms. Intervention women also reported increased communication with their clinician about breast MRI (OR=2.1, 95% CI 1.4-3.1), and the odds of breast MRI in the intervention arm was 5.7-times the odds in the control arm (95% CI 1.6-19.7). In both arms, the majority of women who received breast MRI had a high 5-year breast cancer risk. Measures of distress (difference of -0.12, 95% CI -0.3-0.1) and screening mammography maintenance (OR=1.1, 95% CI 0.8-1.4) were similar across study arms. Conclusions: While uptake of chemoprevention remains low, women at elevated 5-year breast cancer risk can be activated by personalized information without increases in distress or decreases in mammography maintenance. Future work should explore intervention dissemination in the context of mandated breast density notifications nationally.

Keywords: breast cancer screening risk prediction dense breast tissue