Abstract
BackgroundOlder women have poorer survival from breast cancer, which may be at least partly due to poor breast cancer awareness leading to delayed presentation and more advanced stage at diagnosis. In a randomised trial, an intervention to promote early presentation of breast cancer in older women increased breast cancer awareness at 1 year compared with usual care (24 versus 4%). We examined its effectiveness in routine clinical practice.MethodsWe piloted the intervention delivered by practising health professionals to women aged about 70 in four breast screening services. We measured the effect on breast cancer awareness at 1 year compared with comparison services, where women did not receive the intervention.ResultsAt 1 year, 25% of women in pilot services were breast cancer aware compared with 4% in comparison services (p = 0.001). The components of breast cancer awareness were knowledge of breast cancer non-lump symptoms (pilot: 63% vs comparison: 82% at 1 year; OR = 2.56, 95% CI 1.92-3.42), knowledge of age related risk (pilot: 8% vs comparison: 36% at 1 year; OR = 5.56, 95% CI 4.0-7.74) and reported breast checking (pilot: 70% vs comparison: 78% at 1 year; OR = 1.49, 95% CI 1.13-1.96).ConclusionThe intervention may be as effective in routine clinical practice as in a randomised controlled trial. This intervention has the potential to reduce patient delay in the diagnosis of breast cancer in older women.Trial registrationThe PEP trial was registered with the International Standard Registered Clinical/soCial sTudy Number (ISRCTN) as a clinical trial (ISRCTN31994827) on 3rd October 2007.
Highlights
Older women have poorer survival from breast cancer, which may be at least partly due to poor breast cancer awareness leading to delayed presentation and more advanced stage at diagnosis
In a pilot in the National Health Service (NHS) Breast Screening Programme, in which the Promoting Early Presentation (PEP) Intervention was delivered as part of routine clinical practice by NHS radiographers to women of a similar age, breast cancer awareness increased from 4% before the intervention to 38% 1 month later [8]
We examined the effect on the odds ratios of controlling for differences in age, whether they had a husband/partner, age at leaving full-time education and Index of Multiple Deprivation (IMD), a score based on area of residence using data from a number of sources, which provides an estimate of socioeconomic deprivation
Summary
Older women have poorer survival from breast cancer, which may be at least partly due to poor breast cancer awareness leading to delayed presentation and more advanced stage at diagnosis. An intervention to promote early presentation of breast cancer in older women increased breast cancer awareness at 1 year compared with usual care (24 versus 4%). The Promoting Early Presentation (PEP) Intervention was developed to provide older women with the knowledge, motivation, confidence and skills to present promptly on discovering a breast symptom It is a brief, scripted, one-to-one intervention delivered by a health professional in a positive, motivational and collaborative style and supported by a booklet [6, 7]. In a pilot in the National Health Service (NHS) Breast Screening Programme, in which the PEP Intervention was delivered as part of routine clinical practice by NHS radiographers to women of a similar age, breast cancer awareness increased from 4% before the intervention to 38% 1 month later [8]. We aimed to measure whether this effect was maintained after 1 year to the same extent as in the trial
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