Personal Breast Cancer Risk Research Articles

What do women want to see in a personalized breast cancer risk report? A qualitative study of Asian women of two countries.

A breast cancer risk assessment tool for Asian populations, incorporating Polygenic Risk Score and Gail Model algorithm, has been established and validated. However, effective methods for delivering personalized risk information remain underexplored. This study aims to identify and develop effective methods for conveying breast cancer risk information to Asian women. Through ten focus group discussions with 32 women in Indonesia and Singapore, we explored preferences for the presentation of risk information. Participants favored comprehensive reports featuring actionable steps, simplified language, non-intimidating visuals, and personalized risk reduction recommendations. Singaporean participants, more aware of breast cancer prevention, showed a lower likelihood of seeking follow-ups upon receiving low-risk results compared to Indonesians. Overall, participants found the reports useful and advocated for similar approaches in other disease assessments. Balancing content and complexity in reports is crucial, highlighting the need for improved patient understanding and engagement with healthcare providers. Future studies could explore physicians' roles in delivering personalized risk assessments for breast cancer prevention.

Mammography Screening Preferences Among Screening-Eligible Women in Their 40s : A National U.S. Survey.

The U.S. Preventive Services Task Force (USPSTF) recently changed its recommendation for mammography screening from informed decision making to biennial screening for women aged 40 to 49 years. Although many women welcome this change, some may prefer not to be screened at age 40 years. To conduct a national probability-based U.S. survey to investigate breast cancer screening preferences among women aged 39 to 49 years. Pre-post survey with a breast cancer screening decision aid (DA) intervention. (ClinicalTrials.gov: NCT05376241). Online national U.S. survey. 495 women aged 39 to 49 years without a history of breast cancer or a known BRCA1/2 gene mutation. A mammography screening DA providing information about screening benefits and harms and a personalized breast cancer risk estimate. Screening preferences (assessed before and after the DA), 10-year Gail model risk estimate, and whether the information was surprising and different from past messages. Before viewing the DA, 27.0% of participants preferred to delay screening (vs. having mammography at their current age), compared with 38.5% after the DA. There was no increase in the number never wanting mammography (5.4% before the DA vs. 4.3% after the DA). Participants who preferred to delay screening had lower breast cancer risk than those who preferred not to delay. The information about overdiagnosis was surprising for 37.4% of participants versus 27.2% and 22.9% for information about false-positive results and screening benefits, respectively. Respondent preferences may have been influenced by the then-current USPSTF guideline. There are women in their 40s who would prefer to have mammography at an older age, especially after being informed of the benefits and harms of screening. Women who wanted to delay screening were at lower breast cancer risk than women who wanted screening at their current age. Many found information about the benefits and harms of mammography surprising. National Cancer Institute.

Disparities in breast cancer prevention initiatives at a comprehensive cancer center: Who are we serving?

1615 Background: Despite advances in personalized breast cancer risk assessment and screening, populations at highest risk for cancer-related mortality are often excluded. At the IU Simon Comprehensive Cancer Center, a high-risk screening program (HRSP) identifies and serves women at increased risk of breast cancer. Risk assessment using Tyrer Cuzick v.8 and Gail models is performed in mammography; women at increased risk are navigated to a clinic appointment to discuss individualized screening and prevention services including MRI, chemoprevention, and/or genetic testing. We hypothesize gaps in the demographic and socioeconomic (SES) characteristics of women seen for a HRSP appointment, compared to women receiving a cancer diagnosis at the same mammography sites. Methods: Retrospective review was performed of women who met criteria for the HRSP (age ≤65 and Gail 5 yr risk ≥3% or TC v.8 10-yr risk ≥8%, or recommended by the radiologist) and subsequently accepted, scheduled, and attended an appointment from 6/2020 to 6/2022 (n=233). This population was compared to women who were diagnosed with breast cancer at the same clinical sites over the same dates, without history of being evaluated in the HRSP. Age was restricted to ≤65 to match the HRSP population (n=685). Zip codes were used to calculate area-based SES by median household income and percent poverty. CDC social vulnerability index (SVI) was evaluated using the U.S. Census Bureau and American Community Survey (0=least vulnerable, 1=most vulnerable). Comparisons across groups by age, race, insurance status, area SES and SVI were made using the Wilcoxon or Chi-square test. Results: Cancer cases were significantly older than those attending the HRSP (median age 54 vs 49 p < 0.001). Black patients represented 19.4% of participants diagnosed with cancer, versus 10.8% of participants attending the HRSP (p=0.0032). There was also a disparity in insurance coverage, with 83.8% of women seen in the HRSP being privately insured, versus 75.6% of women diagnosed with cancer (p=0.011). There was no statistical difference in SVI (0.64 vs 0.66 p=0.11) or area poverty rate (11.2 vs 12.0 p=0.26) between the groups; cancer cases came from areas with lower household income (69,611 vs 73,165 p=0.04). Conclusions: Women seen in the HRSP were more likely to be younger, White, privately insured, and from an area with higher household income, compared to women diagnosed with cancer in the same health system at the same mammography sites. This highlights disparities in access to individualized breast cancer interception such as chemoprevention, high-risk screening, and genetic testing, which may further existing disparities in breast cancer-related mortality based on race and SES. Further studies will investigate barriers and motivators to personalized breast cancer prevention in high-risk groups, and utilize community partnerships to develop equitable interventions.

Comparing Personal Risk Communication with Generic Information on Breast Cancer Screening Attendance: A Randomized Controlled Trial

Objective: This study sought to discern the differential impacts of communicating individualized breast cancer risk versus disseminating generic breast cancer information on women's proclivity towards breast cancer screenings. Method: A structured experimental design was used, including 300 female volunteers aged between 40-69, who had not previously been diagnosed with breast cancer, in Erzincan. Data collection entailed a face-to-face administration of a 22-item questionnaire complemented by the ASSISTS scale. Participants were randomized into two conditions: one receiving a standardized briefing on breast cancer screening modalities, and the other being apprised of their lifetime risk of breast cancer development based on the modified Gail model. Results: Post-intervention, 55.8% (n=72) of the risk-informed cohort and 40.5% (n=41) of the generic information cohort expressed a willingness to undergo screening (p=0.022). Notably, the group informed of their personalized risk exhibited a more pronounced uptick in requests for breast self-examination, clinical breast examination, and mammography screening compared to their counterparts. Conclusion: The communication of personalized breast cancer risk proves to be a more efficacious and time-efficient strategy than generic information dissemination in bolstering screening participation rates.

Abstract PO3-07-11: Concordance between abbreviated and complete magnetic resonance protocols for screening woman at moderate and high risk for breast cancer

Abstract Introduction: Patients at high risk for developing breast cancer are potential beneficiaries of personalized screening strategies. Breast magnetic resonance imaging (MRI) has shown high sensitivity, but its broader use remains constrained by issues such as high cost and long examination time. The abbreviated magnetic resonance protocol is presented as an alternative to overcome these challenges. Our primary outcome was to evaluate the concordance of the final report between full and abbreviated protocols. Secondary outcomes included the acquisition and reading time of images from the abbreviated protocol. Methods: A cross-sectional study was conducted on asymptomatic women at moderate and high risk for breast cancer who underwent the full MRI screening protocol in private health institutions in the city of Belo Horizonte, Brazil. The abbreviated protocol was derived from the full protocol by the computer through selection of specific sequences. Each image was independently blind read, and assigned a category from the Breast Imaging - Reporting and Data System (BI-RADS) by at least two examiners. The results were then compared using the Cohen's kappa and Intraclass Correlation Coefficients. Results: The study included 170 women, and a concordance rate of 96,9% was found for the reported BI-RADS category between protocols in this population. A 21-minute reduction was observed in examination time for the abbreviated protocol. Conclusion: The significant concordance between protocols indicates that despite the reduction in acquisition time, number of acquired images, and method's complexity, the abbreviated MRI protocol meets most screening demands. It is, therefore, a viable alternative for cost reduction and improving patients tolerability for the studied population. Table 1. Clinical characteristics of the study population Absolute and percentage data about age, personal risk for breast cancer, family history, and previous genetic testing in the study population. Table 2. Concordance analysis between abbreviated and complete MRI protocols based on the ACR-BIRADS classification - Coen Kappa and Intraclass Correlation Coefficient The Kappa value of 0.9687 (95% CI 0.9426 - 0.9949, p < 0.01) indicates almost perfect concordance between the two protocols. The intraclass correlation coefficient of 0.982 (95% CI 0.97 - 0.987, p < 0.01), also indicates excellent concordance using the two-way random effect models criteria. Citation Format: Mariana Mitraud Ottoni Guedes, Agnaldo Lopes da Silva Filho, Thais Paiva Moraes, Adriene Moraes Campos, Ivie Braga de Paula, Felipe Marcondes de Oliveira Coelho, Barbara Silveira Santana, Bertha Andrade Coelho, Maria Fernanda Sperotto Valadares Gontijo, Leticia Martins De Araujo Campos Linhares, Anna Dias Salvador, Waldeir José de Almeida Junior, José Tadeu Campos de Avelar. Concordance between abbreviated and complete magnetic resonance protocols for screening woman at moderate and high risk for breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-07-11.

Abstract B080: Advancing Breast Cancer Risk Prediction: Introducing the Gabbi Risk Assessment Model (GRAM)

Abstract Introduction: Advanced breast cancer risk models hold promise in implementing more effective and accurate screening strategies, facilitating early detection while minimizing screening-related harm compared to current guidelines. However, integrating machine learning risk models into clinical practice requires essential steps to be taken, including continual refinement to enhance their accuracy, validation across diverse populations, and demonstrating their ability to optimize clinical workflows. Gabbi Risk Assessment Model (GRAM), an innovative machine learning model, is a binary classifier based on medical claims developed to provide personalized breast cancer risk prediction. GRAM efficiently estimates risk and utilizes potentially missing risk factor information. Furthermore, it offers easy integration into EMR systems, thus optimizing its practical application. Methods: Construction of the GRAM utilized a medical claims dataset of 500k members from IQVIA carefully sampled from the entire IQVIA population (IQVIA acquires ~94% of the US claims data) with 4 years of history. The information extracted from the dataset included demographics, and medical history in the form of diagnostic and treatment codes, laboratory tests, and medications. The dataset consisted of 250k women aged 18-70 with a breast cancer diagnosis and a random sample of 250k women aged 18-70 without a known breast cancer diagnosis. For the selected cohorts, a 4-year history before the first breast cancer diagnosis was obtained. The control group was carefully chosen to possess similar statistical properties as the group with breast cancer. All women had a minimum enrollment period of 4 years before diagnosis with the same insurance provider. The GRAM was developed with 4 main steps: 1) member selection - members with breast cancer based on selection criteria defined above were in the test group, members without in the control group; 2) feature engineering to ensure that GRAM learns from medical history before a first diagnosis; 3) model development & testing - training/fine tuning using the ensemble methods and neural network, followed by hyperparameter tuning using a held out validation dataset; and 4) model performance on the held out validation set and identification of key risk factors contributing to the breast cancer risk. Results and Conclusion: By addressing these challenges and harnessing the potential of machine learning, GRAM has the capacity to revolutionize breast cancer risk estimation. Its integration into clinical practice can lead to more targeted and efficient screening strategies, resulting in earlier detection and improved patient outcomes. Preliminary results have shown that the GRAM surpasses the current standard of care models (GAIL and Tyrer Cusick) by at least 20% in sensitivity, and AUC ROC with no decline in specificity. GRAM achieved 91% AUC ROC (balanced data), 86% sensitivity, and 80% specificity on a held out dataset. As research progresses, continuous refinement and validation, the GRAM model holds promise to make significant contributions in the fight against breast cancer and identifying the correlated risk factors. Citation Format: Priyanshi Jain, Shaleen K Theiler, Kaitlin Christine. Advancing Breast Cancer Risk Prediction: Introducing the Gabbi Risk Assessment Model (GRAM) [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr B080.

Abstract C126: Communicating breast cancer risk to Spanish-speaking Hispanic women

Abstract INTRODUCTION Disparities in breast cancer (BC) screening are observed between Hispanic and non-Hispanic White women and stronger amongst Hispanic women with under- and uninsured statuses.1-2 Risk-based screening has been recommended by professional societies, including American Cancer Society, starting at age 30 and may be an important strategy for reducing disparities.3 The purpose of the study was to characterize whether women had been told their personal risk of BC and to identify differences in characteristics of patients informed of their personal risk. METHODS This is a cross-sectional analysis of data from a supplemental self-reported survey to an NIH-funded randomized trial conducted at a large Federally Qualified Health Center (FQHC) in Arizona (R01 MD09682-05). The survey was sent to a randomized 600 of the 1,356 participants. Between November 2022 and April 2023, 177 women completed the survey (response rate 29.5%). Participants were asked if a doctor or other healthcare provider had ever talked to them about their personal risk for BC. Differences between those who recalled being told their personal risk for BC and those who did not were assessed using Fisher exact test. RESULTS Overall, 66.3% were 50 years or older, 81.8% who speak primarily Spanish, and 64.8% of respondents had less than a high school education. Also, 22.4% reported a family history of BC, 27.4% have been previously recalled for additional imaging, 10.8% have had a history of prior breast biopsy, 59.9% stated having a regular provider, and 53.1% were found to have dense breast category C or D at screening visit. 40% did not report having a regular doctor although all participants received care at an FQHC. 30.5% of respondents stated that a healthcare professional had ever talked to them about their personal risk for BC. There was a trend toward women with a main doctor being more likely to recall being told their personal risk for BC as compared to those without a main doctor (38.5% vs 22.5%, p=0.06). CONCLUSIONS In this cohort of primarily Spanish-speaking Hispanic women who have had mammography screening and written report of their breast density, about a third of respondents recall being informed of their personal BC risk. These observations need to be confirmed in a larger population with greater response rate, but these results suggest that there is a cohort of patients who need different approaches for conveying risk. REFERENCES 1. Jadav, S., Rajan, S. S., Abughosh, S., & Sansgiry, S. S. (2015). The Role of Socioeconomic Status and Health Care Access in Breast Cancer Screening Compliance Among Hispanics. Journal of Public Health Management and Practice, 21(5), 467–476. https://www.jstor.org/stable/48517175 2. American Cancer Society. (2017). Breast cancer facts & figures 2017-2018. Atlanta, GA: American Cancer Society, Inc. 3. ACS Breast Cancer Screening Guidelines. (2022, January 14). https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.htm Citation Format: Jhenitza P. Raygoza Tapia, Sarah M. Jenkins, Jennifer L. Ridgeway, Aaron D. Norman, Crystal R. Gonzalez, Valentina Hernandez, Bhavika K. Patel, Celine M. Vachon, Jessica D. Austin. Communicating breast cancer risk to Spanish-speaking Hispanic women [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C126.

The benefit of adding polygenic risk scores, lifestyle factors, and breast density to family history and genetic status for breast cancer risk and surveillance classification of unaffected women from germline CHEK2 c.1100delC families

To determine the changes in surveillance category by adding a polygenic risk score based on 311 breast cancer (BC)-associated variants (PRS311), questionnaire-based risk factors and breast density on personalized BC risk in unaffected women from Dutch CHEK2 c.1100delC families.In total, 117 unaffected women (58 heterozygotes and 59 non-carriers) from CHEK2 families were included. Blood-derived DNA samples were genotyped with the GSAMDv3-array to determine PRS311. Lifetime BC risk was calculated in CanRisk, which uses data from the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA). Women, were categorized into three surveillance groups.The surveillance advice was reclassified in 37.9 % of heterozygotes and 32.2 % of non-carriers after adding PRS311. Including questionnaire-based risk factors resulted in an additional change in 20.0 % of heterozygotes and 13.2 % of non-carriers; and a subanalysis showed that adding breast density on top shifted another 17.9 % of heterozygotes and 33.3 % of non-carriers. Overall, the majority of heterozygotes were reclassified to a less intensive surveillance, while non-carriers would require intensified surveillance.The addition of PRS311, questionnaire-based risk factors and breast density to family history resulted in a more personalized BC surveillance advice in CHEK2-families, which may lead to more efficient use of surveillance.

Development and evaluation of a method to assess breast cancer risk using a longitudinal history of mammographic density: a cohort study

BackgroundWomen with dense breasts have an increased risk of breast cancer. However, breast density is measured with variability, which may reduce the reliability and accuracy of its association with breast cancer risk. This is particularly relevant when visually assessing breast density due to variation in inter- and intra-reader assessments. To address this issue, we developed a longitudinal breast density measure which uses an individual woman’s entire history of mammographic density, and we evaluated its association with breast cancer risk as well as its predictive ability.MethodsIn total, 132,439 women, aged 40–73 yr, who were enrolled in Kaiser Permanente Washington and had multiple screening mammograms taken between 1996 and 2013 were followed up for invasive breast cancer through 2014. Breast Imaging Reporting and Data System (BI-RADS) density was assessed at each screen. Continuous and derived categorical longitudinal density measures were developed using a linear mixed model that allowed for longitudinal density to be updated at each screen. Predictive ability was assessed using (1) age and body mass index-adjusted hazard ratios (HR) for breast density (time-varying covariate), (2) likelihood-ratio statistics (ΔLR-χ2) and (3) concordance indices.ResultsIn total, 2704 invasive breast cancers were diagnosed during follow-up (median = 5.2 yr; median mammograms per woman = 3). When compared with an age- and body mass index-only model, the gain in statistical information provided by the continuous longitudinal density measure was 23% greater than that provided by BI-RADS density (follow-up after baseline mammogram: ΔLR-χ2 = 379.6 (degrees of freedom (df) = 2) vs. 307.7 (df = 3)), which increased to 35% (ΔLR-χ2 = 251.2 vs. 186.7) for follow-up after three mammograms (n = 76,313, 2169 cancers). There was a sixfold difference in observed risk between densest and fattiest eight-category longitudinal density (HR = 6.3, 95% CI 4.7–8.7), versus a fourfold difference with BI-RADS density (HR = 4.3, 95% CI 3.4–5.5). Discriminatory accuracy was marginally greater for longitudinal versus BI-RADS density (c-index = 0.64 vs. 0.63, mean difference = 0.008, 95% CI 0.003–0.012).ConclusionsEstimating mammographic density using a woman’s history of breast density is likely to be more reliable than using the most recent observation only, which may lead to more reliable and accurate estimates of individual breast cancer risk. Longitudinal breast density has the potential to improve personal breast cancer risk estimation in women attending mammography screening.

428P What do women want to see in a personalized breast cancer risk report? A qualitative study of Asian women of two countries

428P What do women want to see in a personalized breast cancer risk report? A qualitative study of Asian women of two countries

Toward more personalized breast cancer risk assessment: The polygenic risk score.

Healthcare providers often are uncertain about how best to assess and manage breast cancer risk. Women at average risk wonder when to start mammography and how often to go. Women at increased risk might inquire about genetic testing, MRI screening, and preventive measures. Patients who carry gene mutations face higher stakes and more complex risk management choices, but only some are aware of their status. This article helps clinicians stratify breast cancer risk and discusses a newer genomic test, the polygenic risk score, that may enable more personalized risk management and decision-making.

How do women at increased risk of breast cancer make sense of their risk? An interpretative phenomenological analysis.

Offering breast cancer risk prediction for all women of screening age is being considered globally. For women who have received a clinically derived estimate, risk appraisals are often inaccurate. This study aimed to gain an in-depth understanding of women's lived experiences of receiving an increased breast cancer risk. One-to-one semi-structured telephone interviews. Eight women informed that they were at a 10-year above-average (moderate) or high risk in a breast cancer risk study (BC-Predict) were interviewed about their views on breast cancer, personal breast cancer risk and risk prevention. Interviews lasted between 40 and 70 min. Data were analysed using Interpretative Phenomenological Analysis. Four themes were generated: (i) encounters with breast cancer and perceived personal significance, where the nature of women's lived experiences of others with breast cancer impacted their views on the significance of the disease, (ii) 'It's random really': difficulty in seeking causal attributions, where women encountered contradictions and confusion in attributing causes to breast cancer, (iii) believing versus identifying with a clinically-derived breast cancer risk, where personal risk appraisals and expectations influenced women's ability to internalize their clinically derived risk and pursue preventative action and (iv) perceived utility of breast cancer risk notification, where women reflected on the usefulness of knowing their risk. Providing (numerical) risk estimates appear to have little impact on stable yet internally contradictory beliefs about breast cancer risk. Given this, discussions with healthcare professionals are needed to help women form more accurate appraisals and make informed decisions.

Identifying and addressing barriers to screening mammography in a medically underserved community.

e18685 Background: Breast cancer mortality is 41% higher for Black women than for Non-Hispanic White women. This difference is partly due to disparities in access to high quality screening and timeliness of follow-up of abnormal mammographic findings. This study aimed to identify barriers to mammographic screening and follow-up among a medically underserved, low-income, predominantly Black community in West Philadelphia during a free community screening initiative. Methods: Free breast cancer screening was provided for eligible, average-risk members of the community via a mobile mammography unit for two weeks in June 2022. This initiative was situated as part of a larger, multidisciplinary cancer screening fair that was organized by a collaborative of faculty and staff from our academic hospital and community volunteers. Women attending the fair were offered surveys on access to breast cancer screening. For those who subsequently underwent mobile mammographic screening, health insurance and time to follow-up testing, if needed, were collected from the electronic medical record. Results: 233 women completed surveys (mean age 54±13 years). Among respondents, 93% identified as Black, and 82% reported having a PCP. Of those with a PCP, 55% reported having previously had a breast physical exam, and 56% had been counseled on their personal breast cancer risk. 49% were advised to begin screening by age 40, while the remainder were either counseled to begin at an older age, or were not advised on when to initiate screening. 74% of the cohort endorsed at least one barrier to screening mammography. The most frequently cited barrier was cost and/or lack of insurance coverage (30%), followed by time limitations due to work schedule (21%), fear/anxiety of screening results (20%), fear/anxiety of pain or discomfort (20%), and difficulties with scheduling (19%). Of 181 women who underwent mobile screening mammography, 24 (13%) received a BIRADS 0 assessment, and 11 (6%) went on to undergo breast biopsy. There was a trend toward longer delays between screening and biopsy for women who did not have a PCP (median 45 days, IQR 31–52) compared to those who did (median 24 days, IQR 16–29) (p = 0.072). Three patients who received BIRADS 0 assessments have not yet followed up, all of whom lack health insurance. Conclusions: In this cohort of women from a predominantly Black, medically-underserved community, significant logistical barriers to mammography and follow-up were identified both by self-report and by documented delays in care. Free mobile mammography initiatives that bring medical professionals into the community can help address these barriers, while also providing education and personalized risk assessment. Importantly, sustained engagement is necessary to ensure appropriate follow-up for women found to have additional care needs after screening and is area of future growth for our program.

Will Absolute Risk Estimation for Time to Next Screen Work for an Asian Mammography Screening Population?

Personalized breast cancer risk profiling has the potential to promote shared decision-making and improve compliance with routine screening. We assessed the Gail model's performance in predicting the short-term (2- and 5-year) and the long-term (10- and 15-year) absolute risks in 28,234 asymptomatic Asian women. Absolute risks were calculated using different relative risk estimates and Breast cancer incidence and mortality rates (White, Asian-American, or the Singapore Asian population). Using linear models, we tested the association of absolute risk and age at breast cancer occurrence. Model discrimination was moderate (AUC range: 0.580-0.628). Calibration was better for longer-term prediction horizons (E/Olong-term ranges: 0.86-1.71; E/Oshort-term ranges:1.24-3.36). Subgroup analyses show that the model underestimates risk in women with breast cancer family history, positive recall status, and prior breast biopsy, and overestimates risk in underweight women. The Gail model absolute risk does not predict the age of breast cancer occurrence. Breast cancer risk prediction tools performed better with population-specific parameters. Two-year absolute risk estimation is attractive for breast cancer screening programs, but the models tested are not suitable for identifying Asian women at increased risk within this short interval.

Abstract OT1-15-01: SWOG 1904: Cluster-randomized controlled trial of patient and provider decision support to increase chemoprevention informed choice among women with atypical hyperplasia or lobular carcinoma in situ (MiCHOICE)

Abstract Background: Despite evidence of substantial breast cancer risk reduction, few high-risk women adopt chemopreventive medications such as selective estrogen receptor modulators (SERMs) or aromatase inhibitors (AIs). Women with benign breast disease, such as atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS), have an increased risk of developing breast cancer and derive a greater benefit from antiestrogens compared to other high-risk women. Reasons for low uptake of chemoprevention include insufficient patient and clinician knowledge about antiestrogens, time constraints during the clinical encounter, and concerns about side effects. To address these barriers, we have developed patient and provider web-based decision support tools to improve informed choice about breast cancer chemoprevention among women with AH or LCIS. Study design: We are conducting a cluster-randomized controlled trial of clinical decision support to improve chemoprevention informed choice among women with AH or LCIS and their treating providers. Twenty-six U.S. sites through the SWOG Cancer Research Network were randomly assigned 1:1 to standard educational materials alone or in combination with the patient-centered decision aid (RealRisks) and provider decision support tool (BNAV). A total of 415 patients and 200 healthcare providers will be recruited from these sites. RealRisks consists of interactive modules to calculate personalized breast cancer risk and elicit preferences on chemoprevention. The modules are available in English and Spanish. BNAV is comprised of self-directed case-based learning modules on breast cancer risk assessment and chemoprevention. Patients complete questionnaires at baseline, 6 and 12 months. Providers complete surveys at baseline and after their enrolled patient’s 6-month clinical encounter. The primary endpoint is chemoprevention informed choice at 6 months, using a measure combining knowledge, attitude, and intention scales. Secondary endpoints include perceived breast cancer risk/worry, chemoprevention knowledge/intention, decision conflict/regret, shared decision-making, and chemoprevention uptake. For patients who begin chemoprevention, adherence and reasons for discontinuation are assessed annually for up to 5 years. Barriers and facilitators to implementing RealRisks and BNAV into clinic workflow will be assessed by conducting patient and provider interviews at baseline and mid-implementation. Eligibility criteria: Eligible patients include women, age 35-74 years, with AH or LCIS, no history of breast cancer, no prior use of SERMs or AIs, no bilateral mastectomies, English or Spanish-speaking, and access to the internet. Eligible providers include breast surgeons, medical oncologists, primary care providers, and physician extenders who see patients with AH or LCIS. Statistical methods: We have 90% power to detect a 15% increase in the frequency of chemoprevention informed choice with a 1-sided 0.025 level test, assuming an intraclass correlation (ICC) of 0.02 to account for clustering, roughly equal accrual at each site, 10% loss to follow-up, and ≤10% event rate in the control arm. Current/target accrual: The trial was activated on 9/1/2020. As of 7/7/2022, all 26 sites have been randomized, 157/200 providers and 184/415 patients have been enrolled. Discussion: Our hybrid effectiveness/implementation study seeks to evaluate the effectiveness of a multi-level intervention in promoting informed decision-making about breast cancer chemoprevention. Study results will provide valuable insights on how the decision support tools are integrated in diverse clinical settings. Citation Format: Katherine D. Crew, Garnet Anderson, Kathryn Arnold, Andrew Stieb, Jacquelyn N. Amenta, Cynthia Law, Ana Sandoval-Leon, Sarah Colonna, Tari King, Debra Mangino, Sandhya Pruthi, Maria Grosse Perdekamp, Christa Braun-Inglis, Stacy Krisher, Lisa Yee, Danielle Bertoni, Samantha Seaward, Kari B. Wisinski, Justin Floyd, Corrine Zarwan, Tarah J. Ballinger, Lindi VanderWalde, Masey M. Ross, Preston Steen, Shelly Lo, Alison Conlin, Kathleen Yost, John Ellerton, Erin Lin, Holly J. Pederson, Sagar Sardesai, Cheryl Jernigan, Dawn Hershman, Marian L. Neuhouser, Banu K. Arun, Rita Kukafka. SWOG 1904: Cluster-randomized controlled trial of patient and provider decision support to increase chemoprevention informed choice among women with atypical hyperplasia or lobular carcinoma in situ (MiCHOICE) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-15-01.

Factors Associated With Breast Cancer Screening Behaviors Among Women With Dense Breasts.

We sought to identify patient factors associated with patient-reported screening behaviors in women with dense breasts. An IRB-approved survey study of women with dense breasts presenting for annual screening mammography at an outpatient imaging center was previously conducted from March 2017 to February 2018. The survey included questions regarding mammographic screening frequency and recent participation in supplemental screening. These survey data were combined post hoc with clinical and demographic data and socioeconomic data imputed from census data. Logistic regression was used to identify patient factors associated with reported screening behaviors. Surveys were completed by 508 women (median age, 59.0 years; range, 31.0-86.0 years) with dense breasts. Multivariable analysis demonstrated an independent association of undergoing mammographic screening annually with a history of discussing breast density with a doctor (adjusted odds ratio [AOR], 2.60; P = 0.019). Undergoing supplemental screening in the previous three years was independently associated with younger age (AOR, 1.59; P = 0.004), strong family history of breast cancer (AOR, 3.84; P = 0.027), higher perceived personal risk for breast cancer (AOR, 3.47; P = 0.004), and increased concern about radiation associated with screening examinations (AOR, 3.31; P = 0.006). Women with dense breasts who had discussed breast density with a doctor were more likely to report undergoing annual screening mammography, while younger women and women with a strong family history of breast cancer, higher perceived personal risk for breast cancer, or greater concern about radiation were more likely to report recently undergoing supplemental screening.

Factors associated with perceived personal risk for breast cancer among women with dense breasts

PurposeTo determine what patient factors are associated with a high or an accurate perceived personal risk (PPR) for breast cancer. MethodsAn IRB-approved survey study of women with dense breasts presenting for annual screening mammography was previously conducted from March 2017 to February 2018. Patients were asked to estimate their personal risk for breast cancer and to answer questions about prior breast care-related medical interactions. Survey data were combined post hoc with demographic and clinical data, including breast cancer risk status, and socioeconomic data imputed for each patient from census data. Logistic regression was used to determine which patient factors were associated with a high or accurate PPR. ResultsSurveys were completed by 508 women with dense breasts (median age 59.0 years). A high PPR was independently associated with younger age (AOR, 1.71 [95% CI, 1.13, 2.60]), family history of breast cancer (AOR 4.27 [95% CI, 2.81–7.34]), having a clinical “high-risk” designation (AOR, 3.43 [95% CI, 1.13–10.39], and having been called back from screening (AOR, 1.94 [95% CI, 1.14–3.32]). A lower accuracy of PPR was independently associated with a family history of breast cancer (AOR, 0.25 [95% CI, 0.14–0.42]) and having been called back from screening (AOR, 0.58 [95% CI, 0.35–0.98]). ConclusionWomen with dense breasts who had a family history of breast cancer or who had been called back from screening had a higher but less accurate PPR. Women with a “high-risk” clinical designation had a higher PPR, even when controlling for family history.

Association of patients' primary language, race, and location of care with decision-making for personalized breast cancer risk assessment.

331 Background: Personalized breast cancer risk assessment (CRA) and genetic counseling/testing for women have been shown to improve interventional and clinical outcomes. However, despite CRA being routinely offered to all women at our institution, not all women choose to opt into the program. This study evaluated the demographic distribution of patients that opted out of the CRA to identify potential components influencing this substantial decision. Methods: Our medical center, located in four urban and suburban locations, piloted a clinical framework to provide CRA to all women between the ages of 25 and 75 with a qualifying mammogram. In this single institution retrospective study, we analyzed differences among patients who opted out of the program between July 20, 2020and July 19, 2021. Data elements extracted from the electronic medical record include race, primary language, location of care, and decision to partake in CRA. Overall Chi-square tests and all pairwise comparisons with Bonferroni correction were used to statistically determine the impact of various demographics on opting out. Results: 18726 women met criteria for inclusion and 2717 (14.5%) declined CRA. Within their respective racial groups, 122 (17.6%) Asian, 1175 (16.3%) Black, 455 (14.2%) Hispanic, 112 (15%) Other, and 853 (12.4%) White opted out. Within their identified primary language, 2370 (13.7%) English, 231 (23.1%) Spanish, 35 (19.7%) Bilingual, and 81 (35.2%) Other opted out. Based on their setting of care, 837 (16.8%) Location A, 1436 (14.2%) Location B, 270 (13.8%) Location C, and 174 (10.6%) Location D opted out. The differences between demographics and opting out were statistically significant for all analyses (p <.0001). Results shown in Table below. Conclusions: The main variables mediating the decision to opt out of CRA are a non-English primary language, non-White race, and location of care, potentially due to inadequate interpretation services, barriers to education, and staffing shortages. Thus, these women are less likely to receive genetic counseling/testing or supplemental screening. Our study is the first to investigate the factors contributing to the uptake of risk assessment. Further study is needed to determine the clinical impact of this striking disparity.[Table: see text]

Lifetime personal cigarette smoking and risk of young-onset breast cancer by subtype among non-Hispanic Black and White women in the Young Women's Health History Study.

To evaluate the association between lifetime personal cigarette smoking and young-onset breast cancer (YOBC; diagnosed <50years of age) risk overall and by breast cancer (BC) subtype, and whether risk varies by race or socioeconomic position (SEP). Data are from the Young Women's Health History Study (YWHHS), a population-based case-control study of non-Hispanic Black (NHB) and White (NHW) women, ages 20-49years (n = 1812 cases, n = 1381 controls) in the Los Angeles County and Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER) registry areas, 2010-2015. Lifetime personal cigarette smoking characteristics and YOBC risk by subtype were examined using sample-weighted, multivariable-adjusted polytomous logistic regression. YOBC risk associated with ever versus never smoking differed by subtype (Pheterogeneity = 0.01) with risk significantly increased for Luminal A (adjusted odds ratio [aOR] 1.34; 95% confidence interval [CI] 1.06-1.68) and HER2-type (aOR 1.97; 95% CI 1.23-3.16), and no association with Luminal B or Triple Negative subtypes. Additionally, ≥30years since smoking initiation (versus never) was statistically significantly associated with an increased risk of Luminal A (aOR 1.55; 95% CI 1.07-2.26) and HER2-type YOBC (aOR 2.77; 95% CI 1.32-5.79), but not other subtypes. In addition, among parous women, smoking initiated before first full-term pregnancy (versus never) was significantly associated with an increased risk of Luminal A YOBC (aOR 1.45; 95% CI 1.11-1.89). We observed little evidence for interactions by race and SEP. Findings confirm prior reports of a positive association between cigarette smoking and Luminal A YOBC and identify a novel association between smoking and HER2-type YOBC.

Assessing Risk and Knowledge of Women on Breast Cancer and Providing Lifestyle Advice for the Management of Breast Cancer Risk

Breast cancer is the most common cancer and is the main cause of cancer mortality among women in the world. Overall, 1 in 28 women is likely to develop breast cancer during her lifetime. Although the mortality rate is decreasing, the incidence is persistently increasing due to urbanization and lifestyle changes. So, there is a need to assess the personal breast cancer risk and increase the knowledge of women on early detection. The present study aims to assess the risk and knowledge of women on breast cancer. The main objective of the study is to identify the women at high risk, to create awareness among women about early screening and detection and to educate lifestyle management to decrease breast cancer risk. A descriptive cross-sectional study was performed during the period of June 2019 to November 2019 in the women attended for mammographic examination. A total of 270 women responded to the study. The results showed that five-year risk is found to be high for 31.1% of women and low for 68.8% of women with a mean of 1.4 and the standard deviation is 1.24. About 14.81% of women were found to have strong lifetime risk and 30.37% of women had average lifetime risk and 54.81% women had usual lifetime risk. The mean lifetime risk of the women is 16.09 and the standard deviation is 10.2. The majority of the participants have low knowledge on breast cancer; BSE, and mammography i.e., 80% of them were lack of knowledge. The mean knowledge score is 6.34 and the standard deviation is 5.45. The women who had high five-year and strong lifetime risk are eligible for breast cancer prevention and management approaches. The women with moderate lifetime risk were advised with regular screening and Breast Self-Examination practices.