Effect of personalized breast cancer risk tool on chemoprevention and breast imaging: ENGAGED-2 trial
Mené sur 995 femmes âgées de 40 à 69 ans et à risque élévé de cancer du sein, cet essai randomisé évalue l'intérêt d'un outil en ligne pour les sensibiliser au risque de cancer du sein, dispenser de l'information sur la chimioprévention et améliorer la communication avec les professionnels de santé sur le recours à la mammographie de dépistage
Background : Limited evidence exists about how to communicate breast density-informed breast cancer risk to women at elevated risk to motivate cancer prevention. Methods : We conducted a randomized controlled trial evaluating a web-based intervention incorporating personalized breast cancer risk, information on chemoprevention, and values clarification on chemoprevention uptake vs. active control. Eligible women, aged 40–69 years with normal mammograms and elevated 5-year breast cancer risk, were recruited from Kaiser Permanente Washington from February 2017 to May 2018. Chemoprevention uptake was measured as any prescription for raloxifene or tamoxifen within 12-months from baseline in electronic health record pharmacy data. Secondary outcomes included breast MRI and mammography use and self-reported distress and communication with providers. We calculated unadjusted odds ratios (ORs) using logistic regression models and mean differences using analysis of covariance models with 95% confidence intervals (CIs) with generalized estimating equations. Results : We randomized 995 women (n = 492 intervention arm; 503 control arm). The intervention (vs. control) had no effect on chemoprevention uptake (OR = 1.04, 95% CI = 0.07-to 16.62). The intervention increased breast MRI use (OR = 5.65, 95% CI = 1.61 to19.74), while maintaining annual mammography (OR = 0.98, 95% CI = 0.75 to1.28). Women in the intervention (vs. control) arm had 5.67-times higher odds of having discussed chemoprevention or breast MRI with provider by 6-weeks (OR = 5.67, 95% CI = 2.47 to13.03), and 2.36-times higher odds by 12-months (OR = 2.36, 95% CI = 1.65 to3.37). No measurable differences in distress were detected. Conclusions and relevance : A web-based, patient-level intervention activated women at elevated 5-year breast cancer risk to engage in clinical discussions about chemoprevention, but uptake remained low.
JNCI Cancer Spectrum 2021