A randomised controlled trial of an intervention to promote early presentation of breast cancer in older women: effect on breast cancer awareness

Louise Linsell,Marcia Kapari,Lorraine Tucker,Lynne Omar,Caroline Burgess,Lindsay Forbes,Amanda Ramirez

doi:10.1038/npre.2009.3816.1

Louise Linsell, Marcia Kapari + Show 5 more

Open Access

https://doi.org/10.1038/npre.2009.3816.1

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Abstract

AbstractThere is virtually no evidence for the effectiveness of interventions to promote early presentation in breast cancer. We tested the efficacy of an intervention to equip older women with the knowledge, skills, confidence and motivation to detect symptoms and seek help promptly, with the aim of promoting early presentation with breast cancer symptoms. We randomised 867 women aged 67 to 70 attending for their final routine appointment on the UK NHS Breast Screening Programme to receive: a scripted ten-minute interaction with a radiographer plus a booklet; a booklet alone; or usual care. The primary outcome was whether or not a woman was breast cancer aware based on knowledge of breast cancer symptoms and age-related risk; and reported breast checking. At one month, the intervention increased the proportion who were breast cancer aware compared with usual care (interaction arm: 32.8% versus 4.1%; odds ratio 24.0, 95% confidence interval 7.7 to 73.7; booklet arm: 12.7% versus 4.1%; odds ratio 4.4, 95% confidence interval 1.6 to 12.0). At one year, the effects of the interaction plus booklet, and the booklet, on breast cancer awareness were largely sustained, although the interaction plus booklet remained much more effective. Future research will evaluate whether the intervention promotes early presentation and reduces breast cancer mortality.

Highlights

Women in the UK have poorer survival from breast cancer than many other Western European countries (Berrino et al, 2007), and differences in stage at diagnosis are largely responsible (Sant et al, 2003)
We received breast cancer awareness questionnaires from 89% of those randomised at one month and 83% at one year; response rates were similar in each arm (Figure 1)
The intervention increased breast cancer awareness amongst older women compared with usual care at one month, with the interaction supplemented by a booklet having a greater effect than the booklet alone

Summary

INTRODUCTION

Women in the UK have poorer survival from breast cancer than many other Western European countries (Berrino et al, 2007), and differences in stage at diagnosis are largely responsible (Sant et al, 2003). Risk factors for delay in presentation in breast cancer include older age, less education, and presenting with non-lump symptoms (Ramirez et al, 1999). Older women have poor knowledge of non-lump symptoms and the increase in breast cancer risk with age (Linsell et al, 2008; Grunfeld et al, 2002). We targeted older women because they are at higher risk of breast cancer (Cancer Research UK, 2008), are more likely to delay presentation (Ramirez et al, 1999), and have poorer survival (Office for National Statistics, 2008). We have previously shown in a before-and-after exploratory trial that the intervention increased breast cancer awareness in older women at six months (Burgess et al, 2009). We report here the one month and one year results of a randomised controlled trial of efficacy of the ten-minute interaction with a radiographer supported by a booklet versus the booklet alone versus usual care alone

Participants and setting

RESULTS

DISCUSSION