Randomized Trial of Information for Older Women About Cessation of Breast Cancer Screening Invitations

BACKGROUND

Older women receive no information about why Australia's breast screening program (BreastScreen) invitations cease after 74 years. We tested how providing older women with the rationale for breast screening cessation impacted informed choice (adequate knowledge; screening attitudes aligned with intention).

METHODS

In a three-arm online randomized trial, eligible participants were females aged 70-74 years who had recently participated in breast screening (within 5 years), without personal breast cancer history, recruited through Qualtrics. Participants read a hypothetical scenario in which they received a BreastScreen letter reporting no abnormalities on their mammogram. They were randomized to receive the letter: (1) without any rationale for screening cessation (control); (2) with screening cessation rationale in printed-text form (e.g., downsides of screening outweigh the benefits after age 74); or (3) with screening cessation rationale presented in an animation video form. The primary outcome was informed choice about continuing/stopping breast screening beyond 74 years.

RESULTS

A total of 376 participant responses were analyzed. Compared to controls (n = 122), intervention arm participants (text [n = 132] or animation [n = 122]) were more likely to make an informed choice (control 18.0%; text 32.6%, p = .010; animation 40.5%, p < .001). Intervention arm participants had more adequate knowledge (control 23.8%; text 59.8%, p < .001; animation 68.9%, p < .001), lower screening intentions (control 17.2%; text 36.4%, p < .001; animation 49.2%, p < .001), and fewer positive screening attitudes regarding screening for themselves in the animation arm, but not in the text arm (control 65.6%; text 51.5%, p = .023; animation 40.2%, p < .001).

CONCLUSIONS

Providing information to older women about the rationale for breast cancer screening cessation increased informed decision-making in a hypothetical scenario. This study is an important first step in improving messaging provided by national cancer screening providers direct to older adults. Further research is needed to assess the impact of different elements of the intervention and the impact of providing this information in clinical practice, with more diverse samples.

TRIAL REGISTRATION

ANZCTRN12623000033640.

"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

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.

Oxygen cost and energy expenditure of racquetball

AIM

Many sports are played intermittently in bursts of high, moderate, and low intensity activity. The pattern of exercise intensity has been assessed from heart rate (HR) and time motion analysis and few data are available based on assessment of exercise intensity by means of direct measurement of oxygen uptake. The aim of this study was to directly assess oxygen uptake (VO(2)) using a portable metabolic measuring device to describe the aerobic demand and to determine the associated energy expenditure (EE).

METHODS

Fourteen recreational racquetball players (3 females and 11 males; mean age, height, and mass of 23.1+/-2.8 years, 178.1+/-7.1 cm, and 81.1+/-19.6 kg, respectively) played for 40 min while wearing a portable metabolic system to assess VO(2) and a Polar watch to measure HR. Rating of perceived exertion (RPE) (Borg 6-20 scale) was assessed at 5 min intervals during breaks in play.

RESULTS

The mean VO(2), HR, and RPE over 40 min of play were 27.3+/-1.8 mL/kg/min, 155.3+/-2.8 bpm, and 12.9+/-0.6, respectively. The associated EE was a total of 1 844 kj (440 kcal) or 465 kj/min (11.1 kcal/min). These data were examined across 13.3 min time periods of play, in order to determine if they changed during play because of fatigue. VO(2) decreased significantly (P<0.05), while HR increased (P<0.05). RPE rose across periods of play, but not significantly.

CONCLUSION

Recreational racquetball appears to elicit a VO(2) that would allow aerobic conditioning in many persons. It does so with an RPE that is nearly ''somewhat hard''.

Treadmill vs Steptreadmill Ergometry

In brief: Eighteen college students were tested in five stages on both a treadmill and a revolving stair ergometer. The researchers found no significant differences in peak responses between the two modes-as measured by oxygen consumption, heart rate, ventilation, respiratory exchange ratio, and work time. However, during submaximal exercise in stages I and II, the values for heart rate and oxygen consumption were higher for stair-climbing subjects than for treadmill subjects. These findings support the use of revolving stair ergometers for testing and/or training healthy young adults.

[Theory and practice of sampling studies: exemplified by the MONICA survey]

In parallel with the systematic registration of myocardial infarction, the MONICA-Project attempts to investigate at three different times the prevalence of risk factors for cardiovascular disease in the population. This article presents the sampling plan of the first MONICA survey in the cantons of Vaud, Fribourg and Tessin. The sampling procedure was at two levels: first, a sample of communes stratified according to community size was chosen, and secondly, within these communities, individuals were selected from the population registries. The prerequisites for an efficient sampling plan are discussed on a theoretical level. In addition, the practical constraints (budget, organizational problems, population registry files) are presented. Finally, all steps of the sampling procedure are described including the difficulties encountered. The discussion attempts a critical evaluation of the whole MONICA sampling procedure whose results are largely satisfactory.

[The MONICA survey: analysis of participation]

Participation rates at the first (1985) MONICA survey (representative samples of the Cantons of Vaud, Fribourg and Tessin) are presented. Sample members were invited by phone or letter to the survey (physical examination, blood sample and questionnaire). Overall participation rate was 57% in the french-speaking and 78% in the italian-speaking region. Underrepresented were resident foreigners, women, non-married persons and the aged. If no phone contact was materialized, participation was low. An additional questionnaire for non-responders allows to estimate potential biases in the results of the first MONICA survey.

[Blood lead level in Switzerland in 1985: results of the MONICA survey]

New federal regulations regarding air pollution will soon impose catalysator equipped cars and unleaded fuel. In order to evaluate whether these measures affect the blood lead content in the Swiss population, there will be lead measurements in all three MONICA sample surveys. In the first survey, based on representative population samples, blood lead level was measured in the cantons of Vaud and Fribourg. Results based on 1774 lead measurements indicate a mean blood lead level significantly higher for males than females: 0.63 and 0.44 micromol/l. Work condition as measured by socio-professional category is only related to blood lead among males, while the living environment (community size) is only associated with female blood lead levels. Workers in agriculture and inhabitants of small communes have the lowest blood lead level. In addition, alcohol and tobacco consumption show a strong direct association with blood lead levels and are the two most important potentially confounding factors regarding the relation between blood lead levels and environmental lead pollution.