Breast Cancer Screening Intervention to Improve Adherence to Cancer Control Guidelines in Underserved Minority Women

Abstract

Disparities in breast cancer incidence and outcome between white and African American women are well documented. The overall incidence of breast cancer is higher in white compared to African American women, although this trend is reversed in women under the age of 45. More importantly, breast cancer-related mortality is substantially higher in African Americans compared to white women. The underiying cause of this disparity is likely multifactorial, including differential access to screening and optimal cancer therapy as well as intrinsic biologic differences in tumors developing in white and black patients.

The aim of this study is to develop a strategy for addressing this disparity through cancer risk assessment and prevention. Strategies are available to reduce the impact of this disease in the cohort of women at increased risk through both primary prevention and more effective eariy detection. These advances are reflected in a variety of clinical practice guidelines and consensus statements. These guidelines have defined a new standard of care, which will require widespread use of risk assessment tools in order to provide eligible women with access to chemoprevention, heightened surveillance protocols which include advanced imaging techniques such as breast MRl, referral to genetic specialists for genetic counseling and evaluation for DNA testing and referral for evaluation for surgical approaches to risk-reduction. We propose to test a strategy for providing breast cancer risk screening in primary care for African American and Latina women receiving care at Federally Qualified Health Centers. The risk screening intervention will stratify women into three categories: general population-risk, moderate-risk and high-risk (hereditary breast cancer syndromes). We have developed a computerized risk screening tool which utilizes the Gail/CARE model and Claus model for identifying women in the moderate-risk category and a pedigree assessment tool (PAT) to identify women at risk for hereditary breast cancer syndromes. Management of women in the two increased risk cohorts will follow guidelines developed by the National Comprehensive Cancer Network and specific risk-adapted recommendations are provided to clinicians along with the risk result.

The specific aims of this study include measuring patient adherence with physician recommendations prior to and following risk screening process. We anticipate problems with adherence to the recommendations and will subsequently run a patient navigator program and measure its incremental benefit on patient adherence; and finally measure the impact that knowledge of risk status has on health behaviors of women in all three risk groups.

Research Partner(s)

Chicago Family Health Center

Funding Agency

National Cancer Institute of the National Institutes of Health

 

Principal investigator

Kent Hoskins, MD

 

Co-investigators
Richard T. Campbell, PhD
Javette C. Orgain, MD
Silvia Tejeda, PhD
Richard B. Warnecke, PhD

Start date
07/01/2010
End date
06/30/2015
About this grant

This is a project within a center grant, the Center for Population Health and Health Disparities, 2. Veena Korah, MD, MPH of Chicago Family Health Center is project director.

Read about related research, Mediators of Adherence to Breast Cancer Risk Management among Latina and African American Women at Increased Risk.

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Silva A, Rauscher GH, Hoskins K, Rao R, Ferrans CE. Assessing racial/ethnic disparities in chemotherapy treatment among breast cancer patients in context of changing treatment guidelines. Breast Cancer Res Treat. 2013 Dec;142(3):667-72.