一项针对 40 多岁女性的乳腺癌风险报告的预测试-后测试试验。

A Pre-Test-Post-Test Trial of a Breast Cancer Risk Report for Women in Their 40s.

机构信息

Division of General Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

出版信息

Am J Prev Med. 2020 Sep;59(3):343-354. doi: 10.1016/j.amepre.2020.04.014.

DOI:10.1016/j.amepre.2020.04.014

PMID:32828322

Abstract

INTRODUCTION

Guidelines recommend individualized breast cancer screening and prevention interventions for women in their 40s. Yet, few primary care clinicians assess breast cancer risk.

STUDY DESIGN

Pretest-Posttest trial.

SETTING/PARTICIPANTS: Women aged 40-49 years were recruited from one large Boston-based academic primary care practice between July 2017 and April 2019.

INTERVENTION

Participants completed a pretest, received a personalized breast cancer risk report, saw their primary care clinician, and completed a posttest.

MAIN OUTCOME MEASURES

Using mixed effects models, changes in screening intentions (0-100 scale [0=will not screen to 100=will screen]), mammography knowledge, decisional conflict, and receipt of screening were examined. Analyses were conducted from June 2019 to February 2020.

RESULTS

Patient (n=337) mean age was 44.1 (SD=2.9) years, 61.4% were non-Hispanic white, and 76.6% were college graduates; 306 (90.5%) completed follow-up (203 with 5-year breast cancer risk <1.1%). Screening intentions declined from pre- to post-visit (79.3 to 68.0, p<0.0001), especially for women with 5-year risk <1.1% (77.2 to 63.3, p<0.0001), but still favored screening. In the 2 years prior, 37.6% had screening mammography compared with 41.8% over a mean 16 months follow-up (p=0.17). Mammography knowledge increased and decisional conflict declined. Eleven (3.3%) women met criteria for breast cancer prevention medications (ten discussed medications with their clinicians), 22 (6.5%) for MRI (19 discussed MRI with their clinician), and 67 (19.8%) for genetic counseling (47 discussed with the clinician).

CONCLUSIONS

Receipt of a personalized breast cancer report was associated with women in their 40s making more-informed and less-conflicted mammography screening decisions and with high-risk women discussing breast cancer prevention interventions with clinicians.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.govNCT03180086.

摘要

简介

指南建议为 40 多岁的女性提供个性化的乳腺癌筛查和预防干预措施。然而，很少有初级保健临床医生评估乳腺癌风险。

研究设计

预-后测试试验。

设置/参与者：2017 年 7 月至 2019 年 4 月期间，从一家位于波士顿的大型学术初级保健实践中招募了 40-49 岁的女性。

干预措施

参与者完成了预测试，收到了个性化的乳腺癌风险报告，看了他们的初级保健医生，并完成了后测试。

主要观察指标

使用混合效应模型，检查了筛查意图（0-100 分制[0=不筛查至 100=筛查]）、乳房 X 线照相术知识、决策冲突和筛查的变化。分析于 2019 年 6 月至 2020 年 2 月进行。

结果

患者（n=337）的平均年龄为 44.1（SD=2.9）岁，61.4%为非西班牙裔白人，76.6%为大学毕业生；306（90.5%）完成了随访（203 人有 5 年乳腺癌风险<1.1%）。筛查意图从预测试到后测试下降（79.3 至 68.0，p<0.0001），尤其是 5 年风险<1.1%的女性（77.2 至 63.3，p<0.0001），但仍倾向于筛查。在过去的 2 年中，有 37.6%的人进行了筛查性乳房 X 线照相术，而在平均 16 个月的随访期间，有 41.8%的人进行了乳房 X 线照相术（p=0.17）。乳房 X 线照相术知识增加，决策冲突减少。11 名（3.3%）妇女符合乳腺癌预防药物标准（10 名与临床医生讨论了药物），22 名（6.5%）符合 MRI 标准（19 名与临床医生讨论了 MRI），67 名（19.8%）符合基因咨询标准（47 名与临床医生讨论）。