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Effect of Personalized Breast Cancer Risk Tool on Chemoprevention and Breast Imaging: ENGAGED-2 Trial
BACKGROUND: Limited evidence exists about how to communicate breast density-informed breast cancer risk to women at elevated risk to motivate cancer prevention. METHODS: We conducted a randomized controlled trial evaluating a web-based intervention incorporating personalized breast cancer risk, info...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853161/ https://www.ncbi.nlm.nih.gov/pubmed/33554037 http://dx.doi.org/10.1093/jncics/pkaa114 |
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author | Wernli, Karen J Knerr, Sarah Li, Tengfei Leppig, Kathleen Ehrlich, Kelly Farrell, David Gao, Hongyuan Bowles, Erin J A Graham, Amanda L Luta, George Jayasekera, Jinani Mandelblatt, Jeanne S Schwartz, Marc D O’Neill, Suzanne C |
author_facet | Wernli, Karen J Knerr, Sarah Li, Tengfei Leppig, Kathleen Ehrlich, Kelly Farrell, David Gao, Hongyuan Bowles, Erin J A Graham, Amanda L Luta, George Jayasekera, Jinani Mandelblatt, Jeanne S Schwartz, Marc D O’Neill, Suzanne C |
author_sort | Wernli, Karen J |
collection | PubMed |
description | BACKGROUND: Limited evidence exists about how to communicate breast density-informed breast cancer risk to women at elevated risk to motivate cancer prevention. METHODS: We conducted a randomized controlled trial evaluating a web-based intervention incorporating personalized breast cancer risk, information on chemoprevention, and values clarification on chemoprevention uptake vs active control. Eligible women aged 40-69 years with normal mammograms and elevated 5-year breast cancer risk were recruited from Kaiser Permanente Washington from February 2017 to May 2018. Chemoprevention uptake was measured as any prescription for raloxifene or tamoxifen within 12 months from baseline in electronic health record pharmacy data. Secondary outcomes included breast magnetic resonance imaging (MRI), mammography use, self-reported distress, and communication with providers. We calculated unadjusted odds ratios (ORs) using logistic regression models and mean differences using analysis of covariance models with 95% confidence intervals (CIs) with generalized estimating equations. RESULTS: We randomly assigned 995 women to the intervention arm (n = 492) or control arm (n = 503). The intervention (vs control) had no effect on chemoprevention uptake (OR = 1.04, 95% CI = 0.07 to 16.62). The intervention increased breast MRI use (OR = 5.65, 95% CI = 1.61 to 19.74) while maintaining annual mammography (OR = 0.98, 95% CI = 0.75 to 1.28). Women in the intervention (vs control) arm had 5.67-times higher odds of having discussed chemoprevention or breast MRI with provider by 6 weeks (OR = 5.67, 95% CI = 2.47 to 13.03) and 2.36-times higher odds by 12 months (OR = 2.36, 95% CI = 1.65 to 3.37). No measurable differences in distress were detected. CONCLUSIONS: A web-based, patient-level intervention activated women at elevated 5-year breast cancer risk to engage in clinical discussions about chemoprevention, but uptake remained low. |
format | Online Article Text |
id | pubmed-7853161 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-78531612021-02-04 Effect of Personalized Breast Cancer Risk Tool on Chemoprevention and Breast Imaging: ENGAGED-2 Trial Wernli, Karen J Knerr, Sarah Li, Tengfei Leppig, Kathleen Ehrlich, Kelly Farrell, David Gao, Hongyuan Bowles, Erin J A Graham, Amanda L Luta, George Jayasekera, Jinani Mandelblatt, Jeanne S Schwartz, Marc D O’Neill, Suzanne C JNCI Cancer Spectr Article BACKGROUND: Limited evidence exists about how to communicate breast density-informed breast cancer risk to women at elevated risk to motivate cancer prevention. METHODS: We conducted a randomized controlled trial evaluating a web-based intervention incorporating personalized breast cancer risk, information on chemoprevention, and values clarification on chemoprevention uptake vs active control. Eligible women aged 40-69 years with normal mammograms and elevated 5-year breast cancer risk were recruited from Kaiser Permanente Washington from February 2017 to May 2018. Chemoprevention uptake was measured as any prescription for raloxifene or tamoxifen within 12 months from baseline in electronic health record pharmacy data. Secondary outcomes included breast magnetic resonance imaging (MRI), mammography use, self-reported distress, and communication with providers. We calculated unadjusted odds ratios (ORs) using logistic regression models and mean differences using analysis of covariance models with 95% confidence intervals (CIs) with generalized estimating equations. RESULTS: We randomly assigned 995 women to the intervention arm (n = 492) or control arm (n = 503). The intervention (vs control) had no effect on chemoprevention uptake (OR = 1.04, 95% CI = 0.07 to 16.62). The intervention increased breast MRI use (OR = 5.65, 95% CI = 1.61 to 19.74) while maintaining annual mammography (OR = 0.98, 95% CI = 0.75 to 1.28). Women in the intervention (vs control) arm had 5.67-times higher odds of having discussed chemoprevention or breast MRI with provider by 6 weeks (OR = 5.67, 95% CI = 2.47 to 13.03) and 2.36-times higher odds by 12 months (OR = 2.36, 95% CI = 1.65 to 3.37). No measurable differences in distress were detected. CONCLUSIONS: A web-based, patient-level intervention activated women at elevated 5-year breast cancer risk to engage in clinical discussions about chemoprevention, but uptake remained low. Oxford University Press 2021-01-14 /pmc/articles/PMC7853161/ /pubmed/33554037 http://dx.doi.org/10.1093/jncics/pkaa114 Text en © The Author(s) 2021. Published by Oxford University Press. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Article Wernli, Karen J Knerr, Sarah Li, Tengfei Leppig, Kathleen Ehrlich, Kelly Farrell, David Gao, Hongyuan Bowles, Erin J A Graham, Amanda L Luta, George Jayasekera, Jinani Mandelblatt, Jeanne S Schwartz, Marc D O’Neill, Suzanne C Effect of Personalized Breast Cancer Risk Tool on Chemoprevention and Breast Imaging: ENGAGED-2 Trial |
title | Effect of Personalized Breast Cancer Risk Tool on Chemoprevention and Breast Imaging: ENGAGED-2 Trial |
title_full | Effect of Personalized Breast Cancer Risk Tool on Chemoprevention and Breast Imaging: ENGAGED-2 Trial |
title_fullStr | Effect of Personalized Breast Cancer Risk Tool on Chemoprevention and Breast Imaging: ENGAGED-2 Trial |
title_full_unstemmed | Effect of Personalized Breast Cancer Risk Tool on Chemoprevention and Breast Imaging: ENGAGED-2 Trial |
title_short | Effect of Personalized Breast Cancer Risk Tool on Chemoprevention and Breast Imaging: ENGAGED-2 Trial |
title_sort | effect of personalized breast cancer risk tool on chemoprevention and breast imaging: engaged-2 trial |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853161/ https://www.ncbi.nlm.nih.gov/pubmed/33554037 http://dx.doi.org/10.1093/jncics/pkaa114 |
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