Prior breast density awareness, knowledge, and communication in a health system–embedded behavioral intervention trial

Mahorter, Siobhan; Knerr, Sarah; Bowles, Erin J. Aiello; Wernli, Karen J.; Gao, Hongyuan; Schwartz, Marc D.; O’Neill, Suzanne C.

doi:10.1002/cncr.32711

Cited by 8 publications

(22 citation statements)

References 27 publications

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“…Notably, having been called for follow-up after mammography screening was a strong predictor of BD awareness, conferring over two to four fold higher likelihood of BD awareness with increasing frequency of this experience. These findings are consistent with several prior studies 11,12,33 , and lend further support for the possibility that healthcare encounters in the context of women's breast cancer risk or screening may offer opportunities for communicating BD information to women, and serve as important avenues for increasing BD awareness and knowledge. Specifically, educating women beyond a single risk factor and incorporating other important risk factors for breast cancer (i.e., age, family history, genetic mutations, or prior breast biopsy) can help broaden women's understanding of their personal risk and options for breast cancer screening and prevention.…”

Section: Discussionsupporting

confidence: 90%

Breast Density Awareness and Knowledge in a Mammography Screening Cohort of Predominantly Hispanic Women: Does Breast Density Notification Matter?

Austin

Agovino

Rodríguez

et al. 2021

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: New York State law mandates that women with dense breasts receive a written notification of their breast density (BD) and its implications but data on the impact of dense breast notification (DBN) on BD awareness and knowledge in diverse populations remains limited.Methods: Between 2016 and 2018, we collected survey and mammographic data from 666 women undergoing screening mammography in New York City (ages 40-60, 80% Hispanic, 69% Spanish-speaking) to examine the impact of prior DBN on BD awareness by sociodemographic and breast cancer risk factors, and describe BD knowledge by sources of information.Results: Only 24.8% of the overall sample and 34.9% of women with DBN had BD awareness.In multivariable models adjusting for DBN, awareness was significantly lower in women who were Spanish-speaking (OR 0.16; 95% CI 0.09-0.30 vs. English speakers), foreign-born (OR 0.31; 95% CI 0.16-0.58 vs. U.S.-born), and had lower educational attainment (e.g., high school degree or less OR 0.14; 95 % CI 0.08-0.26 vs college or higher degree). Women with DBN were more likely to be aware of BD (OR 2.61; 95% CI 1.59-4.27) but not more knowledgeable about the impact of BD on breast cancer risk and detection. However, women reporting additional communication about their BD showed greater knowledge in these areas. Conclusions: DBN increases BD awareness disproportionately across sociodemographic groups.Impact: Efforts to improve communication of DBN must focus on addressing barriers in lower socioeconomic and racially and ethnically diverse women, including educational and language barriers.

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Section: Discussionsupporting

confidence: 90%

Breast Density Awareness and Knowledge in a Mammography Screening Cohort of Predominantly Hispanic Women: Does Breast Density Notification Matter?

Austin

Agovino

Rodríguez

et al. 2021

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Within the AZ cohort, we also found significant differences of MBD awareness by various demographic factors, including literacy and educational training. Although we did not limit this cohort by immigration history, this finding is consistent with prior research from Latina focus groups demonstrating that knowledge about breast cancer and health risks is relatively low among Latina immigrants in the United States [16][17][18]. Reasons for a lack of knowledge about breast cancer and health risks are likely multifactorial and may include a lack of discussion about cancer screening in countries of origin [19][20][21][22], embarrassment or fear of breast cancer diagnosis [23], and language barriers in the United States, which may limit the opportunity for breast cancer risk discussions with English-speaking providers.…”

Section: Discussionsupporting

confidence: 83%

Breast Density Knowledge and Awareness Among Latinas in a Low-Resource Setting

Patel

Ridgeway

Jenkins

et al. 2022

Journal of the American College of Radiology

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Purpose: Latinas in low-resource settings face additional barriers to understanding mammographic breast density (MBD) implications. The authors compared MBD awareness and knowledge in Latinas from a safety-net clinic in Arizona with a national sample.Methods: Latinas 40 to 74 years of age were recruited within a safety-net clinic during screening mammography appointments from 2016 to 2019 (AZ cohort) and from a nationally representative online panel in 2017 (NS cohort). Surveys completed in either English or Spanish assessed awareness and knowledge of MBD. Chi-square tests and logistic regression were used for comparisons. Results:The NS cohort (n ¼ 152) was older, more educated, more likely to have undergone prior mammography, and more likely to prefer English compared with the AZ cohort (n ¼ 1,327) (P .03 for all) The NS cohort was more likely to be aware of MBD (32.6% versus 20.7%). Of those aware, the NS cohort was more likely to understand MBD's effect on masking (67.8% versus 37.0%) and breast cancer risk (72.2% versus 32.6%) compared with the AZ cohort (P .001 for all). Adjusting for age, education, screening history, and language, MBD awareness was similar between the two cohorts (adjusted odds ratio [ORadj], 0.95; P ¼ .83), but knowledge of MBD as a masking factor (ORadj, 2.8; P ¼ .03) and risk factor (ORadj, 7.2; P < .001) remained higher in the NS cohort compared with the AZ cohort.Conclusions: Differences in MBD awareness, but not knowledge, between Latinas in a low-resource setting compared with a national sample could be explained by age, education, screening history, and language preference, underscoring the need for tailored approaches to MBD education among Latinas.

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“…Further, we did not specifically evaluate aromatase inhibitor prescriptions as chemoprevention outcome, because the medication was not yet FDA approved as chemoprevention and on formulary at Kaiser Permanente Washington during the study time period. Second, we previously published that our study population had a high level of awareness of breast density ( 39 ) and was demographically homogenous by race and ethnicity, education, and insurance status ( 40 ). Further, women needed to access online information to participate in the study.…”

Section: Discussionmentioning

confidence: 99%

Effect of Personalized Breast Cancer Risk Tool on Chemoprevention and Breast Imaging: ENGAGED-2 Trial

Wernli

Knerr

et al. 2021

JNCI Cancer Spectrum

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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.

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Prior breast density awareness, knowledge, and communication in a health system–embedded behavioral intervention trial

Cited by 8 publications

References 27 publications

Breast Density Awareness and Knowledge in a Mammography Screening Cohort of Predominantly Hispanic Women: Does Breast Density Notification Matter?

Breast Density Awareness and Knowledge in a Mammography Screening Cohort of Predominantly Hispanic Women: Does Breast Density Notification Matter?

Breast Density Knowledge and Awareness Among Latinas in a Low-Resource Setting

Effect of Personalized Breast Cancer Risk Tool on Chemoprevention and Breast Imaging: ENGAGED-2 Trial

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