Improving Screening Uptake among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia

• Type of Material: Article
• Authors: Joseph Lipscomb, Emory University; Ngoc-Cam Escoffery, Emory University; Theresa Gillespie, Emory University; S. Jane Henley, Centers for Disease Control and Prevention; Robert Smith, Emory University; Toni Chociemski, Emory University; Lyn Almon, Emory University; Renjian Jiang, Emory University; Xi Sheng, Emory University; Michael Goodman, Emory University; Kevin Ward, Emory University
• Language: English
• Date: 2020-02-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the authors. Licensee MDPI, Basel, Switzerland.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/ijerph17030977
• Title of Journal or Parent Work: International Journal of Environmental Research and Public Health
• Volume: 17
• Issue: 3
• Grant/Funding Information: The collection of cancer incidence data in Georgia was supported by cooperative agreement 5NU58DP003875-04 from the Centers for Disease Control and Prevention and contract HHSN261201800003I, Task Order HHSN26100001 from the National Cancer Institute.; Statistical analysis and data management expertise was provided by the Winship Cancer Institute of Emory University through support from the National Cancer Institute (P30CA138202).; Project support was provided through a supplemental award of grant number 5 U48-DP001909-05 and U48-DP006377 to the Emory Prevention Research Center (Michelle C. Kegler, DrPH, MPH; principal investigator) from the National Center for Chronic Disease Prevention and Health Promotion of the U.S. Centers for Disease Control and Prevention.
• Keywords: WOMEN; ACCURACY; MEDICAL-RECORD; Public, Environmental & Occupational Health; disease screening; CARE PLANS; Environmental Sciences; Science & Technology; community-based research; first-degree relatives; population-based genetic risk screening; Life Sciences & Biomedicine; guideline adherence; Environmental Sciences & Ecology; cancer registries; breast cancer survivors
• Research Categories: Environmental Sciences; Health Sciences, Public Health; Health Sciences, Oncology

Abstract

Women diagnosed with breast cancer at a relatively early age (≤45 years) or with bilateral disease at any age are at elevated risk for additional breast cancer, as are their female first-degree relatives (FDRs). We report on a randomized trial to increase adherence to mammography screening guidelines among survivors and FDRs. From the Georgia Cancer Registry, breast cancer survivors diagnosed during 2000–2009 at six Georgia cancer centers underwent phone interviews about their breast cancer screening behaviors and their FDRs. Nonadherent survivors and FDRs meeting all inclusion criteria were randomized to high-intensity (evidence-based brochure, phone counseling, mailed reminders, and communications with primary care providers) or low-intensity interventions (brochure only). Three and 12-month follow-up questionnaires were completed. Data analyses used standard statistical approaches. Among 1055 survivors and 287 FDRs who were located, contacted, and agreed to participate, 59.5% and 62.7%, respectively, reported breast cancer screening in the past 12 months and were thus ineligible. For survivors enrolled at baseline (N = 95), the proportion reporting adherence to guideline screening by 12 months post-enrollment was similar in the high and low-intensity arms (66.7% vs. 79.2%, p = 0.31). Among FDRs enrolled at baseline (N = 83), screening was significantly higher in the high-intensity arm at 12 months (60.9% vs. 32.4%, p = 0.03). Overall, about 72% of study-eligible survivors (all of whom were screening nonadherent at baseline) reported screening within 12 months of study enrollment. For enrolled FDRs receiving the high-intensity intervention, over 60% reported guideline screening by 12 months. A major conclusion is that using high-quality central cancer registries to identify high-risk breast cancer survivors and then working closely with these survivors to identify their FDRs represents a feasible and effective strategy to promote guideline cancer screening.