In this project, we propose to develop and test a communication strategy to support clinical decision making about a key step in a personalized breast cancer screening paradigm, the age of initiating breast cancer screening. The absolute benefit of mammography screening varies according to risk of developing breast cancer, a risk that depends upon multiple factors and particularly age. Women at lower risk of breast cancer will experience smaller absolute benefits from screening, but are likely to have the same risk of false positives and other adverse effects. This variation in the risk-benefit ratio of a particular screening strategy according to individual characteristics is fundamental to the personalized screening paradigm. However, there is little evidence about how best to communicate this information to women considering screening. The proposed project includes two phases. In Phase 1, we will conduct a series of experimental studies to examine the effect of alternative communication strategies on comprehension and the correlation between screening intentions and the absolute benefit and risk in the scenarios. Based on recent advances in communication theory and our preliminary work, we will focus on the potential impact of exemplars and of information addressing the expertise and motives of the information sources. In Phase 2, we will test a decision aid based upon the results of Phase 1 in an cross-over, clustered randomized controlled trial in a primary care population, examining its effects on knowledge, decision satisfaction and screening.focusing on the correlation between the absolute benefit of screening and screening utilization. PHS

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
5U54CA163313-03
Application #
8568128
Study Section
Special Emphasis Panel (ZCA1-SRLB-R)
Project Start
Project End
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
3
Fiscal Year
2013
Total Cost
$243,886
Indirect Cost
$90,576
Name
University of Pennsylvania
Department
Type
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Onega, Tracy; Beaber, Elisabeth F; Sprague, Brian L et al. (2014) Breast cancer screening in an era of personalized regimens: a conceptual model and National Cancer Institute initiative for risk-based and preference-based approaches at a population level. Cancer 120:2955-64
Keller, Brad M; Chen, Jinbo; Conant, Emily F et al. (2014) Breast density and parenchymal texture measures as potential risk factors for Estrogen-Receptor positive breast cancer. Proc SPIE Int Soc Opt Eng 9035:90351D
McCarthy, Anne Marie; Kontos, Despina; Synnestvedt, Marie et al. (2014) Screening outcomes following implementation of digital breast tomosynthesis in a general-population screening program. J Natl Cancer Inst 106:
McCarthy, Anne Marie; Armstrong, Katrina (2014) The role of testing for BRCA1 and BRCA2 mutations in cancer prevention. JAMA Intern Med 174:1023-4
Conant, Emily F (2014) Clinical implementation of digital breast tomosynthesis. Radiol Clin North Am 52:499-518
Keller, Brad M; Nathan, Diane L; Gavenonis, Sara C et al. (2013) Reader variability in breast density estimation from full-field digital mammograms: the effect of image postprocessing on relative and absolute measures. Acad Radiol 20:560-8
Daye, Dania; Keller, Brad; Conant, Emily F et al. (2013) Mammographic parenchymal patterns as an imaging marker of endogenous hormonal exposure: a preliminary study in a high-risk population. Acad Radiol 20:635-46