Behavioral and social factors that predict participation in the Breast Cancer Prevention Trial

Characteristics Associated with Participation in ENGAGED 2 - A Web-based Breast Cancer Risk Communication and Decision Support Trial

PURPOSE

We evaluated demographic and clinical characteristics associated with participation in a clinical trial testing the efficacy of an online tool to support breast cancer risk communication and decision support for risk mitigation to determine the generalizability of trial results.

METHODS

Eligible women were members of Kaiser Permanente Washington aged 40-69 years with a recent normal screening mammogram, heterogeneously or extremely dense breasts and a calculated risk of > 1.67% based on the Breast Cancer Surveillance Consortium 5-year breast cancer risk model. Trial outcomes were chemoprevention and breast magnetic resonance imaging by 12-months post-baseline. Women were recruited via mail with phone follow-up using plain language materials notifying them of their density status and higher than average breast cancer risk. Multivariable logistic regression calculated independent odds ratios (ORs) for associations between demographic and clinical characteristics with trial participation.

RESULTS

Of 2,569 eligible women contacted, 995 (38.7%) participated. Women with some college (OR = 1.99, 95% confidence interval [CI] 1.34-2.96) or college degree (OR = 3.35, 95% CI 2.29-4.90) were more likely to participate than high school-educated women. Race/ethnicity also was associated with participation (African-American OR = 0.50, 95% CI 0.29-0.87; Asian OR = 0.22, 95% CI 0.12-0.41). Multivariate adjusted ORs for family history of breast/ovarian cancer were not associated with trial participation.

DISCUSSION

Use of plain language and potential access to a website providing personal breast cancer risk information and education were insufficient in achieving representative participation in a breast cancer prevention trial. Additional methods of targeting and tailoring, potentially facilitated by clinical and community outreach, are needed to facilitate equitable engagement for all women.

The impact of breast cancer awareness and socioeconomic status on willingness to receive breast cancer prevention drugs

PURPOSE

To find associations between knowledge about risk factors for breast cancer and the socioeconomic status of healthy women, as well as their attitude toward taking chemopreventive drugs.

PATIENTS AND METHODS

Between April and September 1999, 7135 healthy women completed questionnaires providing information about their willingness to take chemopreventive drugs. Items in the questionnaire included the sources of the information they had, their estimates of the population and personal lifetime risk, and risk factors for breast cancer.

RESULTS

A total of 6597 questionnaires were evaluable. The responders' median age was 44. Fifty-five percent of the women were willing to consider receiving chemopreventive drugs to lower their risk for breast cancer. Participants who estimated the population risk as being very high were more disposed to receive chemoprevention (65.3%), as were women who estimated their own breast cancer risk as being high (74.1%). A family history of breast cancer only had a low impact on willingness to receive chemoprevention. Women with a family history of breast cancer were willing to take chemopreventive agents in 57.2% of cases. The multivariate analysis showed that knowing about risk factors and having a lower educational level were factors positively correlated with willingness to consider chemoprevention.

CONCLUSION

These findings emphasize the role of estimations of the risk of breast cancer for patients considering whether to accept chemoprevention treatment. To date, only a few modern models of risk estimation have been evaluated in relation to chemoprevention. There is a need for better integration of professional risk estimations into clinical practice.