CRICO Grant Spotlight: Breast Cancer Risk Assessment Among Women 40–49 in Primary Care

Through a CRICO grant-funded project, Mara Schonberg, MD, MPH, sought to learn if providing women age 40–49 with information about their risk of breast cancer is useful to them when deciding on breast cancer screening and prevention interventions.

As part of the study, women in their 40s completed a survey about their risk factors for breast cancer, their intentions to be screened with mammography, any conflicts they had with screening-related decisions, and their knowledge of the risks and benefits of mammography screening before a visit with their primary care provider (PCP). Survey responses were then used to create an individualized two-page risk report.

The study’s aim was to determine the effect of a personalized, risk-based approach for breast cancer screening and prevention for women in their 40s seen in primary care on:

1. women’s intentions to be screened with mammography, knowledge of the pros and cons of mammography screening, and decisional conflict around screening; and
2. patient reports of PCP discussion of their breast cancer risk and of the pros and cons of mammography screening.

As part of the study, 66 of the 337 women who participated were referred to genetic counseling, 17 women at high-risk discussed breast MRI screening with their PCP, six women talked to their PCP about breast cancer prevention medications, and one woman chose to start taking breast cancer prevention medications.

The vast majority (90%) of 78 participating PCPs surveyed reported that, compared to their usual approach, using the risk report resulted in their patients making more informed decisions about mammography screening, with 92% indicating that its use complemented their usual approach. Overall, 96% of participating PCPs surveyed found the individualized risk report helpful; 71% of PCPs surveyed felt it saved them time during visits.

As part of an NIH National Cancer Institute research grant, Dr. Schonberg is developing a breast cancer risk model for women over the age of 55. She plans to make this risk model available online and will use her CRICO study risk report to inform how best to present the output from that model to users. She is also using what she learned about communicating breast cancer risk during her CRICO study to develop a web-based conversation aid to support shared decision-making around mammography screening between primary care clinicians and women over the age of 55. Finally, she is working at the Beth Israel Deaconess Medical Center to integrate breast cancer risk information into the medical record.

For additional information: Contact: [email protected]

Grant-related Publications: American Journal of Preventive Medicine: A Pre-Test−Post-Test Trial of a Breast Cancer Risk Report for Women in Their 40s

Journal of Women’s Health: Variation in Breast Cancer Risk Model Estimates Among Women in Their 40s Seen in Primary Care