This project will investigate the impact of a low-intensity intervention on mammography use. The intervention consists of a self-administered computerized breast cancer risk assessment with subsequent receipt of printed health messages that are tailored to calculated risk. The computerized risk assessment program is based on the Gail model for breast cancer risk calculation. The intervention promotes mammography by applying principles of the expanded Health Belief Model. The health messages are tailored to the individual's level of risk (Usual, Moderate, Strong). This 5-year trial will prospectively evaluate the intervention on women coming for routine visits in a gynecology clinic.
The specific aims are: 1) to assess the impact of the intervention on the primary outcome of mammography practice; 2) to measure the effect of the intervention on the secondary outcomes of breast self-examination, clinical breast exam, risk perceptions, and breast cancer worry; and 3) to understand the mechanism of action of the intervention by assessing the impact of covariates (coping mechanisms, expanded Health Belief Model variables, breast cancer worry, breast cancer risk factors, risk perceptions, discussion of breast cancer with relatives, previous screening practices, intentions to screen, and various demographic variables-age, race, and education) on breast cancer screening. Nine hundred women at least 40 years old will be randomly assigned to intervention or control conditions. All participants will complete baseline surveys while waiting for their appointments. Immediately following the baseline survey, intervention participants will self-administer the computer program (under the guidance of a research assistant) to calculate their breast cancer risks and receive the printed health messages. Belief and behavioral outcomes will be assessed at 1, 6, and 18 months post-intervention by telephone. Follow-up surveys of both groups will measure planned and actual screening including mammography, breast cancer worry, and risk perceptions. This proposal has potential to provide valuable insight on a high-impact outcome (mammography) based on a theoretically-driven, low-intensity intervention. This study distinguishes itself in at least two ways: 1) it investigates health risk assessment among a diverse group of women not necessarily selected for risk status; and 2) it has high practical significance by using a clinical setting. The intervention may lead to early detection, prevention, and a reduction of the burden of breast cancer
