Women who have been treated with chest radiation for a childhood cancer frequently have multiple health problems and have a significantly increased risk of developing breast cancer at a young age (prior to their forties). Although breast cancer surveillance with annual mammography and adjunct breast MRI is recommended starting at age 25, most young women are not obtaining screening. We have conducted preliminary studies to identify important predictors of screening and successfully piloted an intervention leading to increased rates of breast cancer screening among this high risk population. To reduce the breast cancer related morbidity and mortality faced by women who survived childhood cancer, it is imperative to formally test behaviorally-based intervention studies intended to promote breast cancer surveillance. In the proposed 12-month intervention trial, among 330 women who are 25 to 39 years of age and who have not had a mammogram (or similar screening imaging study) in the preceding two years, we will test the efficacy of an intervention aimed at increasing the likelihood of successfully completing the recommended surveillance. The intervention, theoretically founded upon the Transtheoretical Model and the Health Belief Model, consists of a mailed tailored education intervention followed by a stage-based brief motivational interview delivered by telephone. The primary outcome is obtaining a mammogram during the 12-month study period, confirmed by medical record. We hypothesize that women randomized to the intervention group will have a 20% higher rate of screening mammography than women randomized to the attention control group. Secondary aims will include exploring moderating and mediating factors that predict mammogram completion and timing of the obtained surveillance, determining the percent of women who obtain an adjunct breast MRI and explore barriers to completing this imaging test (e.g., insurance/cost, physician authorization), and estimating the intervention replication costs and costs resulting from the intervention. The proposed EMPOWER (Encouraging Mammography/MRI and Preventive Opportunities for Women Exposed to Radiation) study brings together a research team with the necessary expertise and experience in both survivorship research and telephone delivered motivational interviewing with the unique resource of the 26-institution Childhood Cancer Survivor Study (CCSS). Notably, the CCSS represents the single largest cohort of women in the target population and the infrastructure to conduct the proposed study. This study will represent the first randomized controlled trial aimed at promoting breast cancer surveillance among women who are treated with chest radiation for a childhood cancer and will advance our understanding of this vulnerable group.

Public Health Relevance

Secondary to the therapies that cured childhood cancer survivors, most will develop a chronic disease early in life. For example, women treated with chest radiation are at significantly elevated risk of breast cancer at a young age. The proposed study aims to reduce the morbidity and mortality faced by these young women by testing an intervention aimed at promoting early breast cancer detection by screening with mammography.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Special Emphasis Panel (ZCA1-RPRB-7 (J1))
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Breslau, Erica S
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Sloan-Kettering Institute for Cancer Research
New York
United States
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Moskowitz, Chaya S; Chou, Joanne F; Sklar, Charles A et al. (2017) Radiation-associated breast cancer and gonadal hormone exposure: a report from the Childhood Cancer Survivor Study. Br J Cancer 117:290-299
Henderson, Tara O; Moskowitz, Chaya S; Chou, Joanne F et al. (2016) Breast Cancer Risk in Childhood Cancer Survivors Without a History of Chest Radiotherapy: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 34:910-8
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