Recent controversies about breast cancer screening have led to confusion among providers and the public. Our preliminary data and published reports indicate that women in their 40's are confused about the risk of breast cancer, the risks and benefits of mammography and whether and how often to get mammograms. But older women also misperceive the risks of breast cancer and the risks and benefits of mammography, and this may account for some proportion of the underuse of mammography. The overall aim of this project is to enhance informed decision making about mammography for women of different ages by correcting misperceptions about breast cancer risk and the benefits and risks of mammography and by providing age-appropriate tailored feedback with or without telephone counseling. The study will be conducted with 1 ,300 women who are members of the Personal Choice HMO of Blue Cross Blue Shield of North Carolina they will be selected randomly from three age cohorts - women aged 38-42, 48-52 and 58-62. Women will be assigned randomly to usual care, tailored feedback alone or tailored feedback and telephone counseling, with two rounds of intervention and two rounds of follow-up assessment. We will use the CPRU core variables, including measures of the decision making process as well as measures to reflect our two stage-based conceptual models, the Stages of Change Model and the Precaution Adoption Model. As a result of the interventions, we expect to improve the accuracy of women's personal perceptions about breast cancer risk; increase the proportion of women in their 50's and 60's who obtain regular mammograms; increase the discussion of mammography between women and their health providers and improve women's satisfaction with mammography decisions. The results of this study will have application not only for mammography but for other topics in informed decision making as well.
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