Promoting breast cancer surveillance

The EMPOWER study, a randomized clinical trial in the Childhood Cancer Survivor Study

Kevin C. Oeffinger, Jennifer S. Ford, Chaya S. Moskowitz, Joanne F. Chou, Tara O. Henderson, Melissa M. Hudson, Lisa Diller, Aaron McDonald, James Ford, Nidha Z. Mubdi, Dayton Rinehart, Christopher Vukadinovich, Todd M. Gibson, Nassim Anderson, Elena B. Elkin, Kathleen Garrett, Margaret Rebull, Wendy Leisenring, Leslie L. Robison, Gregory Armstrong

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2131-2140
Number of pages10
JournalJournal of Clinical Oncology
Volume37
Issue number24
DOIs
StatePublished - Aug 20 2019

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Survivors
Randomized Controlled Trials
Breast Neoplasms
Breast
Neoplasms
Magnetic Resonance Imaging
Mammography
Telephone
Radiotherapy
Thorax
Physicians
Costs and Cost Analysis
Counseling
Interviews
Control Groups

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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Promoting breast cancer surveillance : The EMPOWER study, a randomized clinical trial in the Childhood Cancer Survivor Study. / Oeffinger, Kevin C.; Ford, Jennifer S.; Moskowitz, Chaya S.; Chou, Joanne F.; Henderson, Tara O.; Hudson, Melissa M.; Diller, Lisa; McDonald, Aaron; Ford, James; Mubdi, Nidha Z.; Rinehart, Dayton; Vukadinovich, Christopher; Gibson, Todd M.; Anderson, Nassim; Elkin, Elena B.; Garrett, Kathleen; Rebull, Margaret; Leisenring, Wendy; Robison, Leslie L.; Armstrong, Gregory.

In: Journal of Clinical Oncology, Vol. 37, No. 24, 20.08.2019, p. 2131-2140.

Research output: Contribution to journalArticle

Oeffinger, KC, Ford, JS, Moskowitz, CS, Chou, JF, Henderson, TO, Hudson, MM, Diller, L, McDonald, A, Ford, J, Mubdi, NZ, Rinehart, D, Vukadinovich, C, Gibson, TM, Anderson, N, Elkin, EB, Garrett, K, Rebull, M, Leisenring, W, Robison, LL & Armstrong, G 2019, 'Promoting breast cancer surveillance: The EMPOWER study, a randomized clinical trial in the Childhood Cancer Survivor Study', Journal of Clinical Oncology, vol. 37, no. 24, pp. 2131-2140. https://doi.org/10.1200/JCO.19.00547
Oeffinger, Kevin C. ; Ford, Jennifer S. ; Moskowitz, Chaya S. ; Chou, Joanne F. ; Henderson, Tara O. ; Hudson, Melissa M. ; Diller, Lisa ; McDonald, Aaron ; Ford, James ; Mubdi, Nidha Z. ; Rinehart, Dayton ; Vukadinovich, Christopher ; Gibson, Todd M. ; Anderson, Nassim ; Elkin, Elena B. ; Garrett, Kathleen ; Rebull, Margaret ; Leisenring, Wendy ; Robison, Leslie L. ; Armstrong, Gregory. / Promoting breast cancer surveillance : The EMPOWER study, a randomized clinical trial in the Childhood Cancer Survivor Study. In: Journal of Clinical Oncology. 2019 ; Vol. 37, No. 24. pp. 2131-2140.
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abstract = "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.",
author = "Oeffinger, {Kevin C.} and Ford, {Jennifer S.} and Moskowitz, {Chaya S.} and Chou, {Joanne F.} and Henderson, {Tara O.} and Hudson, {Melissa M.} and Lisa Diller and Aaron McDonald and James Ford and Mubdi, {Nidha Z.} and Dayton Rinehart and Christopher Vukadinovich and Gibson, {Todd M.} and Nassim Anderson and Elkin, {Elena B.} and Kathleen Garrett and Margaret Rebull and Wendy Leisenring and Robison, {Leslie L.} and Gregory Armstrong",
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T1 - Promoting breast cancer surveillance

T2 - The EMPOWER study, a randomized clinical trial in the Childhood Cancer Survivor Study

AU - Oeffinger, Kevin C.

AU - Ford, Jennifer S.

AU - Moskowitz, Chaya S.

AU - Chou, Joanne F.

AU - Henderson, Tara O.

AU - Hudson, Melissa M.

AU - Diller, Lisa

AU - McDonald, Aaron

AU - Ford, James

AU - Mubdi, Nidha Z.

AU - Rinehart, Dayton

AU - Vukadinovich, Christopher

AU - Gibson, Todd M.

AU - Anderson, Nassim

AU - Elkin, Elena B.

AU - Garrett, Kathleen

AU - Rebull, Margaret

AU - Leisenring, Wendy

AU - Robison, Leslie L.

AU - Armstrong, Gregory

PY - 2019/8/20

Y1 - 2019/8/20

N2 - 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.

AB - 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.

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