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Best R, Wilkinson LS, Oliver-Williams C, Tolani F, Yates J. Should we share breast density information during breast cancer screening in the United Kingdom? an integrative review. Br J Radiol 2023; 96:20230122. [PMID: 37751169 PMCID: PMC10646652 DOI: 10.1259/bjr.20230122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/25/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Dense breasts are an established risk factor for breast cancer and also reduce the sensitivity of mammograms. There is increasing public concern around breast density in the UK, with calls for this information to be shared at breast cancer screening. METHODS We searched the PubMed database, Cochrane Library and grey literature, using broad search terms in October 2022. Two reviewers extracted data and assessed the risk of bias of each included study. The results were narratively synthesised by five research questions: desire for information, communication formats, psychological impact, knowledge impact and behaviour change. RESULTS We identified 19 studies: three Randomised Controlled Trials (RCTs), three cohort studies, nine cross-sectional studies, one qualitative interview study, one mixed methods study and two 2021 systematic reviews. Nine studies were based in the United States of America (USA), five in Australia, two in the UK and one in Croatia. One systematic review included 14 USA studies, and the other 27 USA studies, 1 Australian and 1 Canadian. The overall GRADE evidence quality rating for each research question was very low to low.Generally, participants wanted to receive breast density information. Conversations with healthcare professionals were more valued and effective than letters. Breast density awareness after notification varied greatly between studies.Breast density information either did not impact frequency of mammography screening or increased the intentions of participants to return for routine screening as well as intention to access, and uptake of, supplementary screening. People from ethnic minority groups or of lower socioeconomic status (SES) had greater confusion following notification, and, along with those without healthcare insurance, were less likely to access supplementary screening. CONCLUSION Breast density specific research in the UK, including different communities, is needed before the UK considers sharing breast density information at screening. There are also practical considerations around implementation and recording, which need to be addressed. ADVANCES IN KNOWLEDGE Currently, sharing breast density information at breast cancer screening in the UK may not be beneficial to participants and could widen inequalities. UK specific research is needed, and measurement, communication and future testing implications need to be carefully considered.
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Affiliation(s)
- Rebecca Best
- NHS England Screening Quality Assurance Service, Health Education England, England, United Kingdom
| | | | - Clare Oliver-Williams
- NHS England Screening Quality Assurance Service, Health Education England, England, United Kingdom
| | - Foyeke Tolani
- Public Health Department, Bedford Borough Council, Bedford, United Kingdom
| | - Jan Yates
- NHS England Screening Quality Assurance Service, Health Education England, England, United Kingdom
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2
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Nickel B, Armiger J, Saunders C, Vincent W, Dodd RH, Temple A, Bhola N, Verde A, Houssami N. "I haven't had that information, even though I think I'm really well-informed about most things": a qualitative focus group study on Australian women's understanding and views of potentially modifiable risk factors for breast cancer. BMC Womens Health 2023; 23:211. [PMID: 37118726 PMCID: PMC10147360 DOI: 10.1186/s12905-023-02363-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Building health literacy about potentially modifiable risk factors for breast cancer may help to empower women to make more informed decisions about their breast health; however there has been limited qualitative research on this topic. This study aimed to explore current knowledge, understanding and experience of potentially modifiable risk factors for breast cancer, and views on current and future communication strategies for this information and related interventions. METHODS Qualitative study using online focus groups via Zoom in October-November 2022. A diverse sample of women from the Australian community aged 40-74 years were recruited. RESULTS Fifty-one women from a range of socioeconomic backgrounds took part in nine focus groups. General knowledge of risk factors for breast cancer in the community is limited, particularly in relation to modifiable factors such as alcohol consumption and postmenopausal obesity, with many women describing feelings of 'shock' following this information. Women overwhelming believed that information on modifiable risk factors for breast cancer should be communicated more widely, however communication preferences for receiving this information varied. There was a strong preference amongst the women for a cascade of information which they believed may then help target greater number of women of all ages and backgrounds. Despite worry about long-term compliance, women also supported various lifestyle interventions which may help them and other women to reduce their overall risk. CONCLUSIONS Findings from this study highlight the need for more widespread community communication and education about risk factors for breast, in particular potentially modifiable risk factors such as alcohol consumption and postmenopausal obesity. As breast screening programs in Australia and globally begin to evaluate the potential for risk-related screening this will provide an additional context for primary prevention, hence planning of messaging and piloting of lifestyle-related prevention strategies in breast cancer is needed now. Gaining an understanding of women's preferences for communication and forms of interventions is vital to ensure their engagement.
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Affiliation(s)
- Brooke Nickel
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Camperdown, NSW, Australia.
- Wiser Healthcare, School of Public Health, The University of Sydney, Camperdown, NSW, Australia.
| | - Josephine Armiger
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | | | - Wendy Vincent
- BreastScreen NSW Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Rachael H Dodd
- The Daffodil Centre, A joint venture between Cancer Council NSW, Faculty of Medicine and Health, The University of Sydney, The University of Sydney, Camperdown, NSW, Australia
| | - Anthea Temple
- BreastScreen NSW, Cancer Institute NSW, Camperdown, NSW, Australia
| | - Nalini Bhola
- BreastScreen NSW, Cancer Institute NSW, Camperdown, NSW, Australia
| | - Angela Verde
- Breast Cancer Network Australia, Victoria, Australia
| | - Nehmat Houssami
- Wiser Healthcare, School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- The Daffodil Centre, A joint venture between Cancer Council NSW, Faculty of Medicine and Health, The University of Sydney, The University of Sydney, Camperdown, NSW, Australia
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Grigg J, Manning V, Lockie D, Giles M, Bell R, Stragalinos P, Bernard C, Volpe I, Greenwood CJ, Smith L, Bragge P, Lubman DI. A Brief Intervention for Improving Alcohol Literacy and Addressing Harmful Alcohol use Among Women Attending an Australian Breast Screening Service (Health4Her): Protocol for a Hybrid Effectiveness-Implementation Trial (Preprint). JMIR Res Protoc 2022; 12:e44867. [PMID: 36995739 PMCID: PMC10131813 DOI: 10.2196/44867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Alcohol consumption is a major modifiable risk factor for female breast cancer, even in small amounts. However, awareness of this risk remains low. National breast screening programs are uniquely positioned to provide timely and targeted health information and behavior change strategies to improve alcohol literacy and reduce consumption. A breast screening service is a novel health care setting for brief alcohol intervention, with the potential for extensive reach. OBJECTIVE This study aimed to conduct a formative evaluation with breast screening service consumers to understand the need for, and acceptability of, brief alcohol intervention in the breast screening setting and collaboratively design a brief alcohol intervention (Health4Her); to test the effectiveness of Health4Her in improving knowledge of alcohol as a breast cancer risk factor (primary outcome), improving alcohol literacy, and reducing consumption among women attending a breast screening service; and to examine the implementation strategy through process evaluation. METHODS This was a hybrid type II effectiveness-implementation trial comprising a randomized controlled trial (RCT) alongside a mixed methods program evaluation guided by applicable elements of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and Consolidated Framework for Implementation Research. Formative evaluation comprised a retrospective analysis of alcohol consumption data (n=49,240), a web-based survey (n=391), and focus groups and interviews (n=31) with breast screening service consumers. Women attending routine mammography, drinking at any level, were recruited to the single-site, double-blind RCT (n=558), and completed a baseline assessment before randomization (1:1) to receive Health4Her (alcohol brief intervention + lifestyle information) or control (lifestyle information) via animation on an iPad. Follow-up assessments were performed 4 and 12 weeks after randomization. The process evaluation included evaluation of trial administrative data, participant quantitative (n=497) and qualitative feedback (n=30), and site staff qualitative feedback (n=11). RESULTS This research was funded in March and May 2019. Data collection for the formative evaluation and trial recruitment occurred between January and April 2020 and February and August 2021, respectively, with finalization of follow-up data collection in December 2021. Quantitative process evaluation data were collected during trial implementation, and collection of participant and staff feedback was finalized in December 2021. Results of the retrospective analysis of alcohol consumption data from breast screening service consumers is anticipated to be published in March 2023 and the results of the RCT to be published in March 2023. CONCLUSIONS This study is anticipated to generate new substantial knowledge on the alcohol consumption and literacy needs of women attending breast screening and the extent to which these can be addressed using a novel, tailored brief alcohol intervention. The study design permits the evaluation of the effectiveness and implementation of Health4Her to predict and facilitate uptake in breast screening services. TRIAL REGISTRATION ClinicalTrials.gov NCT04715516; https://clinicaltrials.gov/ct2/show/NCT04715516. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/44867.
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Affiliation(s)
- Jasmin Grigg
- Turning Point, Eastern Health, Melbourne, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Victoria Manning
- Turning Point, Eastern Health, Melbourne, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Darren Lockie
- Maroondah BreastScreen, Eastern Health, Melbourne, Australia
| | - Michelle Giles
- Maroondah BreastScreen, Eastern Health, Melbourne, Australia
| | - Robin Bell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Christopher J Greenwood
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Liam Smith
- BehaviourWorks Australia, Monash University, Melbourne, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash University, Melbourne, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Melbourne, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Usher-Smith J, von Wagner C, Ghanouni A. Behavioural Challenges Associated With Risk-Adapted Cancer Screening. Cancer Control 2022; 29:10732748211060289. [PMID: 34986038 PMCID: PMC8744170 DOI: 10.1177/10732748211060289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cancer screening programmes have a major role in reducing cancer incidence and mortality. Traditional internationally-adopted protocols have been to invite all 'eligible individuals' for the same test at the same frequency. However, as highlighted in Cancer Research UK's 2020 strategic vision, there are opportunities to increase effectiveness and cost-effectiveness, and reduce harms of screening programmes, by making recommendations on the basis of personalised estimates of risk. In some respects, this extends current approaches of providing more intensive levels of care outside screening programmes to individuals at very high risk due to their family history or underlying conditions. However, risk-adapted colorectal cancer screening raises a wide range of questions, not only about how best to change existing programmes but also about the psychological and behavioural effects that these changes might have. Previous studies in other settings provide some important information but remain to be tested and explored further in the context of colorectal screening. Conducting behavioural science research in parallel to clinical research will ensure that risk-adapted screening is understood and accepted by the population that it aims to serve.
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Affiliation(s)
- Juliet Usher-Smith
- The Primary Care Unit, Department of Public
Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Christian von Wagner
- Research Department of Behavioural Science
and Health, Institute of Epidemiology and Health Care
UCL, London, UK
| | - Alex Ghanouni
- Research Department of Behavioural Science
and Health, Institute of Epidemiology and Health Care
UCL, London, UK
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5
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Exploring Implementation of Personal Breast Cancer Risk Assessments. J Pers Med 2021; 11:jpm11100992. [PMID: 34683136 PMCID: PMC8541275 DOI: 10.3390/jpm11100992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/21/2021] [Accepted: 09/25/2021] [Indexed: 11/16/2022] Open
Abstract
Personal Breast Cancer (BC) Risk Assessments (PBCRA) have potential to stratify women into clinically-actionable BC risk categories. As this could involve population-wide genomic testing, women's attitudes to PBCRA and views on acceptable implementation platforms must be considered to ensure optimal population participation. We explored these issues with 31 women with different BC risk profiles through semi-structured focus group discussions or interviews. Inductive thematic coding of transcripts was performed. Subsequently, women listed factors that would impact on their decision to participate. Participants' attitudes to PBCRA were positive. Identified themes included that PBCRA acceptance hinges on result actionability. Women value the ability to inform decision-making. Participants reported anxiety, stress, and genetic discrimination as potential barriers. The age at which PBCRA was offered, ease of access, and how results are returned held importance. Most women value the opportunity for PBCRA to inform increased surveillance, while highlighting hesitance to accept reduced surveillance as they find reassurance in regular screening. Women with BRCA pathogenic variants value the potential for PBCRA to identify a lower cancer risk and potentially inform delayed prophylactic surgery. This study highlights complexities in adopting advances in BC early detection, especially for current users who value existing processes as a social good.
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Usher‐Smith JA, Harvey‐Kelly LLW, Rossi SH, Harrison H, Griffin SJ, Stewart GD. Acceptability and potential impact on uptake of using different risk stratification approaches to determine eligibility for screening: A population-based survey. Health Expect 2021; 24:341-351. [PMID: 33264472 PMCID: PMC8077132 DOI: 10.1111/hex.13175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/15/2020] [Accepted: 11/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Using risk stratification approaches to determine eligibility has the potential to improve efficiency of screening. OBJECTIVES To compare the public acceptability and potential impact on uptake of using different approaches to determine eligibility for screening. DESIGN An online population-based survey of 668 adults in the UK aged 45-79 including a series of scenarios in the context of a potential kidney cancer screening programme in which eligibility was determined by age, sex, age and sex combined, a simple risk score (age, sex, body mass index, smoking status), a complex risk score additionally incorporating family history and lifestyle, or a genetic risk score. OUTCOME MEASURES We used multi-level ordinal logistic regression to compare acceptability and potential uptake within individuals and multivariable ordinal logistic regression differences between individuals. RESULTS Using sex, age and sex, or the simple risk score were less acceptable than age (P < .0001). All approaches were less acceptable to women than men. Over 70% were comfortable waiting until they were older if the complex risk score or genetics indicated a low risk. If told they were high risk, 85% would be more likely to take up screening. Being told they were low risk had no overall influence on uptake. CONCLUSIONS Varying the starting age of screening based on estimated risk from models incorporating phenotypic or genetic risk factors would be acceptable to most individuals and may increase uptake. PATIENT OR PUBLIC CONTRIBUTION Two members of the public contributed to the development of the survey and have commented on this paper.
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Affiliation(s)
- Juliet A. Usher‐Smith
- The Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | | | - Sabrina H. Rossi
- Department of OncologyUniversity of Cambridge, Addenbrooke’s Hospital, Cambridge Biomedical CampusCambridgeUK
| | - Hannah Harrison
- The Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Simon J. Griffin
- The Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Grant D. Stewart
- Department of SurgeryUniversity of Cambridge, Addenbrooke’s Hospital, Cambridge Biomedical CampusCambridgeUK
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7
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Anderson AS, Chong HY, Craigie AM, Donnan PT, Gallant S, Hickman A, McAdam C, McKell J, McNamee P, Macaskill EJ, Mutrie N, O'Carroll RE, Rauchhaus P, Sattar N, Stead M, Treweek S. A novel approach to increasing community capacity for weight management a volunteer-delivered programme (ActWELL) initiated within breast screening clinics: a randomised controlled trial. Int J Behav Nutr Phys Act 2021; 18:34. [PMID: 33676538 PMCID: PMC7936444 DOI: 10.1186/s12966-021-01099-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/08/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND It is estimated that around 30% of breast cancers in post-menopausal women are related to lifestyle. The breast cancer-pooling project demonstrated that sustained weight loss of 2 to 4.5 kg is associated with an 18% lower risk of breast cancer, highlighting the importance of small changes in body weight. Our study aimed to assess the effectiveness a volunteer-delivered, community based, weight management programme (ActWELL) for women with a BMI > 25 kg/m2 attending NHS Scotland Breast Screening clinics. METHODS A multicentre, 1:1 parallel group, randomised controlled trial was undertaken in 560 women aged 50 to 70 years with BMI > 25 kg/m2. On completion of baseline measures, all participants received a breast cancer prevention leaflet. Intervention group participants received the ActWELL intervention which focussed on personalised diet advice and pedometer walking plans. The programme was delivered in leisure centres by (the charity) Breast Cancer Now volunteer coaches. Primary outcomes were changes between groups at 12 months in body weight (kg) and physical activity (accelerometer measured step count). RESULTS Two hundred seventy-nine women were allocated to the intervention group and 281 to the comparison group. Twelve-month data were available from 240 (81%) intervention and 227 (85%) comparison group participants. Coaches delivered 523 coaching sessions and 1915 support calls to 279 intervention participants. Mean weight change was - 2.5 kg (95% CI - 3.1 to - 1.9) in the intervention group and - 1.2 kg (- 1.8 to 0.6) in the comparison group. The adjusted mean difference was - 1.3 kg (95% CI - 2.2 to - 0.4, P = 0.003). The odds ratio for losing 5% weight was 2.20 (95% CI 1.4 to 3.4, p = 0.0005) in favour of the intervention. The adjusted mean difference in step counts between groups was 483 steps/day (95% CI - 635 to 1602) (NS). CONCLUSIONS A community weight management intervention initiated at breast screening clinics and delivered by volunteer coaches doubled the likelihood of clinically significant weight loss at 12 months (compared with usual care) offering significant potential to decrease breast cancer risk. TRIAL REGISTRATION Database of registration: ISCRTN. Registration number: 11057518 . Date trial registered:21.07.2017. Date of enrolment of first participant: 01.09.2017.
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Affiliation(s)
- Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK.
| | - Huey Yi Chong
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Angela M Craigie
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Peter T Donnan
- Division of Population Health and Genomics, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Stephanie Gallant
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Amy Hickman
- Breast Cancer Now, 222 Leith Walk, Edinburgh, EH6 5EQ, UK
| | - Chloe McAdam
- Physical Activity for Health Research Centre, University of Edinburgh, Saint Leonard's Land, Holyrood Rd, Edinburgh, EH8 8AQ, UK
| | - Jennifer McKell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - E Jane Macaskill
- Department of Breast Surgery, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Saint Leonard's Land, Holyrood Rd, Edinburgh, EH8 8AQ, UK
| | | | - Petra Rauchhaus
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Naveed Sattar
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow, G12 8TA, UK
| | - Martine Stead
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, , Room 306, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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8
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Mbuya-Bienge C, Pashayan N, Brooks JD, Dorval M, Chiquette J, Eloy L, Turgeon A, Lambert-Côté L, Paquette JS, Lévesque E, Hagan J, Walker MJ, Lapointe J, Dalpé G, Granados Moreno P, Blackmore K, Wolfson M, Joly Y, Broeders M, Knoppers BM, Chiarelli AM, Simard J, Nabi H. Women's Views on Multifactorial Breast Cancer Risk Assessment and Risk-Stratified Screening: A Population-Based Survey from Four Provinces in Canada. J Pers Med 2021; 11:jpm11020095. [PMID: 33540785 PMCID: PMC7912955 DOI: 10.3390/jpm11020095] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 12/03/2022] Open
Abstract
Risk-stratified screening for breast cancer (BC) is increasingly considered as a promising approach. However, its implementation is challenging and needs to be acceptable to women. We examined Canadian women’s attitudes towards, comfort level about, and willingness to take part in BC risk-stratified screening. We conducted an online survey in women aged 30 to 69 years in four Canadian provinces. In total, 4293 women completed the questionnaire (response rate of 63%). The majority of women (63.5% to 72.8%) expressed favorable attitudes towards BC risk-stratified screening. Most women reported that they would be comfortable providing personal and genetic information for BC risk assessment (61.5% to 67.4%) and showed a willingness to have their BC risk assessed if offered (74.8%). Most women (85.9%) would also accept an increase in screening frequency if they were at higher risk, but fewer (49.3%) would accept a reduction in screening frequency if they were at lower risk. There were few differences by province; however, outcomes varied by age, education level, marital status, income, perceived risk, history of BC, prior mammography, and history of genetic test for BC (all p ≤ 0.01). Risk-based BC screening using multifactorial risk assessment appears to be acceptable to most women. This suggests that the implementation of this approach is likely to be well-supported by Canadian women.
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Affiliation(s)
- Cynthia Mbuya-Bienge
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College, London WC1E 6BT, UK;
| | - Jennifer D. Brooks
- Dalla Lana School of Public Health Science, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
| | - Michel Dorval
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Faculty of Pharmacy, Université Laval, Quebec City, QC G1V 4G2, Canada
- CISSS de Chaudière-Appalaches Research Center, Lévis, QC G6V 3Z1, Canada
| | - Jocelyne Chiquette
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- CHU de Québec—Université Laval, Quebec City, QC G1S 4L8, Canada
- Département de Médecine Familiale et de Médecine d’Urgence, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | - Laurence Eloy
- Québec Cancer Program, Ministère de la Santé et des Services Sociaux, Quebec City, QC G1S 2M1, Canada;
| | - Annie Turgeon
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Laurence Lambert-Côté
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Jean-Sébastien Paquette
- Département de Médecine Familiale et de Médecine d’Urgence, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | - Emmanuelle Lévesque
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | - Julie Hagan
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | - Meghan J. Walker
- Dalla Lana School of Public Health Science, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
- Ontario Health, Cancer Care Ontario, Toronto, ON M5G 2L3, Canada;
| | - Julie Lapointe
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Gratien Dalpé
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | - Palmira Granados Moreno
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | | | - Michael Wolfson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada;
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | - Mireille Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, 525 EZ Nijmegen, The Netherlands;
- Dutch Expert Centre for Screening, 6538 SW Nijmegen, The Netherlands
| | - Bartha M. Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | - Anna M. Chiarelli
- Dalla Lana School of Public Health Science, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
- Ontario Health, Cancer Care Ontario, Toronto, ON M5G 2L3, Canada;
| | - Jacques Simard
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 4G2, Canada
| | - Hermann Nabi
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Université Laval Cancer Research Center, Quebec City, QC G1R 3S3, Canada
- Correspondence: ; Tel.: +1-418-682-7511 (ext. 82800)
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9
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Rainey L, van der Waal D, Broeders MJM. Dutch women's intended participation in a risk-based breast cancer screening and prevention programme: a survey study identifying preferences, facilitators and barriers. BMC Cancer 2020; 20:965. [PMID: 33023516 PMCID: PMC7539478 DOI: 10.1186/s12885-020-07464-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/27/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Risk-based breast cancer screening may improve the benefit-harm ratio of screening by tailoring policy to a woman's personal breast cancer risk. This study aims to explore Dutch women's preferences regarding the organisation and implementation of a risk-based breast cancer screening and prevention programme, identifying potential barriers and facilitators to uptake. METHODS A total of 5110 participants in the Dutch Personalised RISk-based MAmmography screening (PRISMA) study were invited, of whom 942 completed a two-part web-based survey. The first part contained questions about personal characteristics; for the second part, women were randomly assigned to one of four hypothetical breast cancer risk scenarios (i.e. low, average, moderate, or high) with subsequent tailored screening and prevention advice. Descriptive statistics are used to present women's organisational preferences. Univariable and multivariable logistic regression analyses were performed using seven proxy measures for acceptability of risk-based screening (e.g., interest in risk) and risk-based prevention (e.g., willingness to change diet). RESULTS Interest in breast cancer risk was high (80.3%). Higher assigned risk scenario was most consistently associated with acceptance of tailored screening and prevention recommendations. Increased acceptance of lifestyle changes was additionally associated with higher education. Having a first degree family history of breast cancer decreased women's motivation to participate in preventative lifestyle measures. Acceptability of medication was associated with a woman's general beliefs about the (over)use and benefit-harm balance of medication. CONCLUSIONS Dutch women generally appear in favour of receiving their breast cancer risk estimate with subsequent tailored screening and prevention recommendations. However, women's level of acceptance depends on their assigned risk category. Offering tailored screening and prevention recommendations to low-risk women will be most challenging. Educating women on the benefits and harms of all risk-based screening and prevention strategies is key to acceptability and informed decision-making.
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Affiliation(s)
- Linda Rainey
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Daniëlle van der Waal
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands
| | - Mireille J M Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands
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10
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Sinclair J, McCann M, Sheldon E, Gordon I, Brierley-Jones L, Copson E. The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics. BMJ Open 2019; 9:e027371. [PMID: 31209091 PMCID: PMC6609127 DOI: 10.1136/bmjopen-2018-027371] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Potentially modifiable risk factors account for approximately 23% of breast cancers, with obesity and alcohol being the two greatest. Breast screening and symptomatic clinical attendances provide opportunities ('teachable moments') to link health promotion and breast cancer-prevention advice within established clinical pathways. This study explored knowledge and attitudes towards alcohol as a risk factor for breast cancer, and potential challenges inherent in incorporating advice about alcohol health risks into breast clinics and screening appointments. DESIGN A mixed-method study including a survey on risk factors for breast cancer and understanding of alcohol content. Survey results were explored in a series of five focus groups with women and eight semi-structured interviews with health professionals. SETTING Women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in those settings. PARTICIPANTS 205 women were recruited (102 NHSBSP attenders and 103 symptomatic breast clinic attenders) and 33 NHS Staff. RESULTS Alcohol was identified as a breast cancer risk factor by 40/205 (19.5%) of attenders and 16/33 (48.5%) of staff. Overall 66.5% of attenders drank alcohol, and 56.6% could not estimate correctly the alcohol content of any of four commonly consumed alcoholic drinks. All women agreed that including a prevention-focussed intervention would not reduce the likelihood of their attendance at screening mammograms or breast clinics. Qualitative data highlighted concerns in both women and staff of how to talk about alcohol and risk factors for breast cancer in a non-stigmatising way, as well as ambivalence from specialist staff as to their role in health promotion. CONCLUSIONS Levels of alcohol health literacy and numeracy were low. Adding prevention interventions to screening and/or symptomatic clinics appears acceptable to attendees, highlighting the potential for using these opportunities as 'teachable moments'. However, there are substantial cultural and systemic challenges to overcome if this is to be implemented successfully.
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Affiliation(s)
- Julia Sinclair
- Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark McCann
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ellena Sheldon
- Core Trainee in Psychiatry, Peninsula Postgraduate Medical Education, Plymouth, UK
| | - Isabel Gordon
- Department of Pharmacy Health and Well-being, University of Sunderland, Sunderland, UK
| | - Lyn Brierley-Jones
- Department of Sociology, University of York, Wentworth College, York, UK
| | - Ellen Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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11
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Chambers SE, Copson ER, Dutey-Magni PF, Priest C, Anderson AS, Sinclair JMA. Alcohol use and breast cancer risk: A qualitative study of women's perspectives to inform the development of a preventative intervention in breast clinics. Eur J Cancer Care (Engl) 2019; 28:e13075. [PMID: 31038252 PMCID: PMC6767031 DOI: 10.1111/ecc.13075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/18/2019] [Accepted: 03/25/2019] [Indexed: 12/29/2022]
Abstract
Objective This study aimed to explore women's views about breast cancer risk and alcohol use, to inform the design of a prototype for an intervention in breast clinics about alcohol as a modifiable risk factor for breast cancer. Methods Women recruited in NHS breast screening and symptomatic clinics in Southampton, UK, were invited to take part in semi‐structured telephone interviews or a focus group to discuss their perspectives of breast cancer risk, alcohol consumption and their information needs about these topics. Data were analysed thematically. Twenty‐eight women took part in telephone interviews, and 16 attended one of three focus groups. Results While most women reported a personal responsibility for their health and were interested in advice about modifiable risk factors, few without (or prior to) experience of breast symptoms independently sought information. Many considered alcohol advice irrelevant as the association with breast cancer was largely unknown, and participants did not consider their drinking to be problematic. Women reported trusting information from health organisations like the NHS, but advice needs to be sensitive and non‐blaming. Conclusion NHS breast screening and symptomatic clinics offer a “teachable moment” to engage women with context‐specific advice about alcohol and cancer risk that, if targeted correctly, may assist them in making informed lifestyle choices.
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Affiliation(s)
- Sophia E Chambers
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ellen R Copson
- Cancer Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, UK
| | - Peter F Dutey-Magni
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Institute of Health Informatics, University College London, London, UK
| | - Caspian Priest
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | - Julia M A Sinclair
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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12
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Anderson AS, Craigie AM, Gallant S, McAdam C, Macaskill EJ, Mutrie N, Neilson AR, O'Carroll RE, Rauchhaus P, Sattar N, Stead M, Treweek S. Randomised controlled trial to assess the impact of a lifestyle intervention (ActWELL) in women invited to NHS breast screening. BMJ Open 2018; 8:e024136. [PMID: 30413516 PMCID: PMC6231585 DOI: 10.1136/bmjopen-2018-024136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In Scotland, the incidence of breast cancer is predicted to rise significantly in the next few decades and while there are measures to support reductions in morbidity and mortality, the breast cancer community is currently exploring preventative opportunities including supporting weight management programmes in postmenopausal women. This study aims to assess the effectiveness and cost-effectiveness of a theory-based, community delivered, minimal contact, weight management (diet, physical activity and behaviour change techniques) programme (ActWELL) in women with a body mass index (BMI) >25 kg/m2 attending routine breast cancer screening appointments. METHODS AND ANALYSIS The study will be a four-centre, 1:1 parallel group randomised controlled trial of a 12-month weight management intervention initiated in breast cancer screening centres, delivered by trained Breast Cancer Now lifestyle coaches in community settings. The intervention programme involves two intervention meetings with coaches plus (up to) nine telephone contacts over 12 months. The programme will focus on personalised diet (including alcoholic and sugary drinks) and physical activity habits. Behaviour change techniques include self-monitoring, goal setting, implementation intentions, action and coping plans. The study has a sample size of 414 women with a BMI >25 kg/m2 attending routine National Health Service breast cancer screening appointments. Measures will be taken at baseline, 12 weeks and at 12-month follow-up, complemented by qualitative interviews exploring perceived acceptability and impact on habitual behaviours. The two co-primary outcomes are mean change in measured body weight and change in physical activity between groups to 12 months. Secondary outcomes are changes in eating habits, alcohol intake, sedentary time, quality of life, waist circumference, lipid, haemoglobin A1c and insulin profiles, blood pressure and cost-effectiveness of the intervention. ETHICS AND DISSEMINATION The protocol has been approved by East of Scotland Research Ethics Committee (17/ES/0073). All participants provide written informed consent. Dissemination will be through peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN11057518; Pre-results.
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Affiliation(s)
- Annie S Anderson
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Division of Population Health and Genomics, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Angela Mary Craigie
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Division of Population Health and Genomics, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Stephanie Gallant
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Division of Population Health and Genomics, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Chloe McAdam
- Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - E Jane Macaskill
- Department of Breast Surgery, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Ronan E O'Carroll
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, Tayside Medical Sciences Centre, Ninewells Hospital and Medical School, Dundee, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Martine Stead
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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13
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Esserman LJ. The WISDOM Study: breaking the deadlock in the breast cancer screening debate. NPJ Breast Cancer 2017; 3:34. [PMID: 28944288 PMCID: PMC5597574 DOI: 10.1038/s41523-017-0035-5] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/09/2017] [Accepted: 07/11/2017] [Indexed: 11/17/2022] Open
Abstract
There are few medical issues that have generated as much controversy as screening for breast cancer. In science, controversy often stimulates innovation; however, the intensely divisive debate over mammographic screening has had the opposite effect and has stifled progress. The same two questions—whether it is better to screen annually or bi-annually, and whether women are best served by beginning screening at 40 or some later age—have been debated for 20 years, based on data generated three to four decades ago. The controversy has continued largely because our current approach to screening assumes all women have the same risk for the same type of breast cancer. In fact, we now know that cancers vary tremendously in terms of timing of onset, rate of growth, and probability of metastasis. In an era of personalized medicine, we have the opportunity to investigate tailored screening based on a woman’s specific risk for a specific tumor type, generating new data that can inform best practices rather than to continue the rancorous debate. It is time to move from debate to wisdom by asking new questions and generating new knowledge. The WISDOM Study (Women Informed to Screen Depending On Measures of risk) is a pragmatic, adaptive, randomized clinical trial comparing a comprehensive risk-based, or personalized approach to traditional annual breast cancer screening. The multicenter trial will enroll 100,000 women, powered for a primary endpoint of non-inferiority with respect to the number of late stage cancers detected. The trial will determine whether screening based on personalized risk is as safe, less morbid, preferred by women, will facilitate prevention for those most likely to benefit, and adapt as we learn who is at risk for what kind of cancer. Funded by the Patient Centered Outcomes Research Institute, WISDOM is the product of a multi-year stakeholder engagement process that has brought together consumers, advocates, primary care physicians, specialists, policy makers, technology companies and payers to help break the deadlock in this debate and advance towards a new, dynamic approach to breast cancer screening.
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Affiliation(s)
- Laura J Esserman
- Department of Surgery and Radiology, University of California, San Francisco, CA USA
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