Promoting Breast Cancer Surveillance: The EMPOWER Study, a Randomized Clinical Trial in the Childhood Cancer Survivor Study.

Autor:	Oeffinger KC; 1Duke University, Durham, NC., Ford JS; 2Hunter College, City University of New York, New York, NY.; 3The Graduate Center of the City University of New York, New York, NY., Moskowitz CS; 4Memorial Sloan Kettering Cancer Center, New York, NY., Chou JF; 4Memorial Sloan Kettering Cancer Center, New York, NY., Henderson TO; 5The University of Chicago, Chicago, IL., Hudson MM; 6St Jude Children's Research Hospital, Memphis, TN., Diller L; 7Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA., McDonald A; 6St Jude Children's Research Hospital, Memphis, TN., Ford J; 6St Jude Children's Research Hospital, Memphis, TN., Mubdi NZ; 4Memorial Sloan Kettering Cancer Center, New York, NY., Rinehart D; 6St Jude Children's Research Hospital, Memphis, TN., Vukadinovich C; 6St Jude Children's Research Hospital, Memphis, TN., Gibson TM; 6St Jude Children's Research Hospital, Memphis, TN., Anderson N; 4Memorial Sloan Kettering Cancer Center, New York, NY., Elkin EB; 4Memorial Sloan Kettering Cancer Center, New York, NY., Garrett K; 8University of Colorado School of Public Health, Denver, CO., Rebull M; 9University of Vermont, Burlington, VT., Leisenring W; 10Fred Hutchinson Cancer Research Center, Seattle, WA., Robison LL; 6St Jude Children's Research Hospital, Memphis, TN., Armstrong GT; 6St Jude Children's Research Hospital, Memphis, TN.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2019 Aug 20; Vol. 37 (24), pp. 2131-2140. Date of Electronic Publication: 2019 Jul 01.
DOI:	10.1200/JCO.19.00547
Abstrakt:	Purpose: The aim of the current study was to increase the uptake of screening mammography among high-risk women who were treated for a childhood cancer with chest radiotherapy. Patients and Methods: Two hundred four female survivors in the Childhood Cancer Survivor Study who were treated with chest radiotherapy with 20 Gy or greater, age 25 to 50 years, and without breast imaging in the past 24 months were randomly assigned 2:1 to receive a mailed informational packet followed by a tailored telephone-delivered brief motivational interview (intervention) versus an attention control. Primary outcome was the difference in the proportion of participants who completed a screening mammogram by 12 months as evaluated in an intent-to-treat analysis. Stratum-adjusted relative risk (RR) and 95% CI were estimated using the Cochran-Mantel-Haenszel method. Secondary outcomes included the completion of screening breast magnetic resonance imaging (MRI) and barriers to screening and moderating factors. Results: Women in the intervention group were significantly more likely than those in the control group to report a mammogram (45 [33.1%] of 136 v 12 [17.6%] of 68; RR, 1.9; 95% CI, 1.1 to 3.3). The intervention was more successful among women age 25 to 39 years (RR, 2.2; 95% CI, 1.1 to 4.7) than among those age 40 to 50 years (RR, 1.4; 95% CI, 0.6 to 3.2). The proportion of women who reported a breast MRI at 12 months was similar between the two groups: 16.2% (intervention) compared with 13.2% (control; RR, 1.2; 95% CI, 0.6 to 2.5). Primary barriers to completing a screening mammogram and/or breast MRI included lack of physician recommendation, deferred action by survivor, cost, and absence of symptoms. Conclusion: Use of mailed materials followed by telephone-delivered counseling increased mammography screening rates in survivors at high risk for breast cancer; however, this approach did not increase the rate of breast MRI. Cost of imaging and physician recommendation were important barriers that should be addressed in future studies.
Databáze:	MEDLINE
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