scholarly journals Perceptions of racially/ethnically diverse women at high-risk for breast cancer regarding use of a web-based decision aid on chemoprevention: A qualitative study nested within a randomized controlled trial (Preprint)

2020 ◽  
Author(s):  
Tarsha Jones ◽  
Ashlee Guzman ◽  
Thomas Silverman ◽  
Katherine Freeman-Costin ◽  
Rita Kukafka ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Information Needs ◽  
Controlled Trial ◽  
Cancer Chemoprevention ◽  
User Characteristics ◽  
Web Based ◽  
High Risk Women

BACKGROUND : Chemopreventive agents such as selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) have proven efficacy in reducing breast cancer risk by 41%-79% in high risk women. Women at high risk of developing breast cancer face the complex decision of whether to take SERMs or AIs for breast cancer chemoprevention. RealRisks, is a patient-centered web-based decision aid (DA) that was designed to promote understanding of breast cancer risk and to engage diverse women in planning a preference-sensitive course of decision-making about taking chemoprevention. OBJECTIVE We aimed to understand perceptions of women at high-risk for developing breast cancer regarding their experience using RealRisks, a DA designed to promote uptake of breast cancer chemoprevention and to understand their information needs. METHODS We completed enrollment to a randomized controlled trial (RCT) among 300 racially/ethnically diverse women at high-risk of breast cancer, who were assigned to standard educational materials alone or in combination with RealRisks. We conducted semi-structured interviews with a subset of 27 high-risk women enrolled in the intervention arm of the RCT who initially accessed the tool on average one-year prior, to understand how they interacted with the tool. All interviews were audio-recorded, transcribed verbatim, and compared against the digital audio recordings to ensure accuracy of the content. We used content analysis to generate themes. RESULTS The mean age of the 27 participants was 60.9 years (SD=10.3). Participants were 18.5% non-Hispanic black, 14.8% Hispanic/Latina, and 3.7% Asian. Most participants (78%) reported using RealRisks after being granted access to the DA. Four overarching themes emerged from the qualitative analyses: (1) acceptability of the intervention, (2) specifically endorsed elements of the DA, (3) recommendations for improvements, and (4) information needs. Most women who used RealRisks found it acceptable (n=21/27) and considered it to be helpful. Most women (n=13/21) reported that RealRisks was easy to navigate, user-friendly, and easily accessible online. The majority felt that RealRisks improved their knowledge about breast cancer risk and chemoprevention options (n=18/21), and that RealRisks informed their decision-making about whether or not to take chemoprevention (n=17/21). Some women (n=9/21) shared recommendations for improvements, as they wanted more tailoring based upon user characteristics, felt the DA was targeting a narrow population of Hispanic/Latina by using graphic novel-style narratives, wanted more understandable terminology, and felt that the tool had too strong of an emphasis on chemoprevention drugs. Participants also shared their information needs on mammography screening frequency and modifiable lifestyle factors. CONCLUSIONS This qualitative study has demonstrated the acceptability of the RealRisks web-based DA among a diverse group of high-risk women with some recommendations for improvement. These results emphasize the need for more tailoring of the DA based on user characteristics, a comprehensive approach to reducing breast cancer risk, and information needs.

scholarly journals Addressing Barriers to Uptake of Breast Cancer Chemoprevention for Patients and Providers

2015 ◽  
pp. e50-e58 ◽  
Author(s):  
Katherine D. Crew
Keyword(s):  
Breast Cancer ◽  
Primary Prevention ◽  
High Risk ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Cancer Chemoprevention ◽  
The United States ◽  
Cancer Risk Assessment ◽  
Breast Cancer Risk Assessment ◽  
Breast Cancer Chemoprevention

Breast cancer is the most common malignancy among women in the United States, and the primary prevention of this disease is a major public health issue. Because there are relatively few modifiable breast cancer risk factors, pharmacologic interventions with antiestrogens have the potential to significantly affect the primary prevention setting. Breast cancer chemoprevention with selective estrogen receptor modulators (SERMs) tamoxifen and raloxifene, and with aromatase inhibitors (AIs) exemestane and anastrozole, is underutilized despite several randomized controlled trials demonstrating up to a 50% to 65% relative risk reduction in breast cancer incidence among women at high risk. An estimated 10 million women in the United States meet high-risk criteria for breast cancer and are potentially eligible for chemoprevention, but less than 5% of women at high risk who are offered antiestrogens for primary prevention agree to take it. Reasons for low chemoprevention uptake include lack of routine breast cancer risk assessment in primary care, inadequate time for counseling, insufficient knowledge about antiestrogens among patients and providers, and concerns about side effects. Interventions designed to increase chemoprevention uptake, such as decision aids and incorporating breast cancer risk assessment into clinical practice, have met with limited success. Clinicians can help women make informed decisions about chemoprevention by effectively communicating breast cancer risk and enhancing knowledge about the risks and benefits of antiestrogens. Widespread adoption of chemoprevention will require a major paradigm shift in clinical practice for primary care providers (PCPs). However, enhancing uptake and adherence to breast cancer chemoprevention holds promise for reducing the public health burden of this disease.

scholarly journals Effect of Bazedoxifene and Conjugated Estrogen (Duavee) on Breast Cancer Risk Biomarkers in High-Risk Women: A Pilot Study

2019 ◽  
Vol 12 (10) ◽  
pp. 711-720 ◽  
Author(s):  
Carol J. Fabian ◽  
Lauren Nye ◽  
Kandy R. Powers ◽  
Jennifer L. Nydegger ◽  
Amy L. Kreutzjans ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Pilot Study ◽  
High Risk ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
High Risk Women ◽  
Risk Biomarkers ◽  
Conjugated Estrogen

scholarly journals Exercise lowers estrogen and progesterone levels in premenopausal women at high risk of breast cancer

2011 ◽  
Vol 111 (6) ◽  
pp. 1687-1693 ◽  
Author(s):  
D. A. Kossman ◽  
N. I. Williams ◽  
S. M. Domchek ◽  
M. S. Kurzer ◽  
J. E. Stopfer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Menstrual Cycle ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Luteal Phase ◽  
Premenopausal Women ◽  
High Risk Women ◽  
Estrogen Exposure ◽  
Hormone Exposure

Experimental and clinical data support a role for estrogens in the development and growth of breast cancer, and lowered estrogen exposure reduces breast cancer recurrence and new diagnoses in high-risk women. There is varied evidence that increased physical activity is associated with breast cancer risk reduction in both pre- and postmenopausal women, perhaps via lowered estrogen levels. The purpose of this study was to assess whether exercise intervention in premenopausal women at increased breast cancer risk reduces estrogen or progesterone levels. Seven healthy premenopausal women at high risk for breast cancer completed a seven-menstrual-cycle study. The study began with two preintervention cycles of baseline measurement of hormone levels via daily first-morning urine collection, allowing calculation of average area under the curve (AUC) hormone exposure across the menstrual cycle. Participants then began five cycles of exercise training to a maintenance level of 300 min per week at 80–85% of maximal aerobic capacity. During the last two exercise cycles, urinary estradiol and progesterone levels were again measured daily. Total estrogen exposure declined by 18.9% and total progesterone exposure by 23.7%. The declines were mostly due to decreased luteal phase levels, although menstrual cycle and luteal phase lengths were unchanged. The study demonstrated the feasibility of daily urine samples and AUC measurement to assess hormone exposure in experimental studies of the impact of interventions on ovarian hormones. The results suggest value in exercise interventions to reduce hormone levels in high-risk women with few side effects and the potential for incremental benefits to surgical or pharmacologic interventions.

Implementing decision support for breast cancer chemoprevention in primary care.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13038-e13038 ◽  
Author(s):  
Jersen Telfort ◽  
Meghna S. Trivedi ◽  
Hae Seung Yi ◽  
Hilary Colbeth ◽  
Alejandro Vanegas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Decision Support ◽  
High Risk ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Primary Care Providers ◽  
Categorical Variables ◽  
High Risk Women ◽  
Before And After

e13038 Background: Breast cancer risk assessment and chemoprevention with anti-estrogens among high-risk women are underutilized. We developed web-based decision support tools for high-risk women, RealRisks, and their primary care providers (PCPs), BNAV, which are integrated into clinic workflow. Methods: We conducted a pilot study in 50 women who were found to have a 5-year risk of invasive breast cancer ≥1.67% according to the Gail model during screening mammography. RealRisks includes modules on breast cancer risk and chemoprevention, as well as interactive games to communicate risk and preference elicitation for chemoprevention. A tailored patient and provider action plan is generated summarizing their breast cancer risk profile. Before and after interacting with RealRisks, participants completed validated questionnaires on breast cancer and chemoprevention knowledge and chemoprevention intention. Prior to their next clinic visit, their PCPs were given access to the BNAV reference toolbox. High-risk referrals and chemoprevention uptake were assessed by medical chart review. Paired t-tests and chi-square tests were used to analyze continuous and categorical variables pre/post-intervention, respectively. Results: From Mar to Aug 2016, 50 high-risk women were enrolled and 40 were evaluable. Median age 64.5 years (range, 49-72); white/black/Hispanic (%): 37.5/25/37.5; 35% had adequate health literacy; median 5-year breast cancer risk was 2.2% (range, 1.7-3.9). Before and after interacting with RealRisks, we observed an increase in adequate breast cancer knowledge (60% vs. 84%, p = .01) and chemoprevention knowledge (5% vs. 25%, p < .01). After viewing RealRisks, 30% of women were interested in taking an anti-estrogen for chemoprevention, 33% not interested, and 37% unsure. Thus far, only 2 were referred for high-risk consultations and no high-risk women initiated chemoprevention. Conclusions: Despite increased interest in chemoprevention after exposure to RealRisks, additional barriers to chemoprevention uptake exist, including competing comorbidities and time constraints during the clinical encounter. Targeting younger women with higher breast cancer risk may increase chemoprevention uptake. Clinical trial information: NCT02954900.

scholarly journals ATM haplotypes and breast cancer risk in Jewish high-risk women

2006 ◽  
Vol 94 (10) ◽  
pp. 1537-1543 ◽  
Author(s):  
M Koren ◽  
G Kimmel ◽  
E Ben-Asher ◽  
I Gal ◽  
M Z Papa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
High Risk Women
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