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