Impact of breast density information disclosure in racially diverse populations

乳腺密度信息披露对不同种族人群的影响

基本信息

批准号：
9923468
负责人：
Parisa Tehranifar
金额：
$ 52.52万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-01 至 2021-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9923468
关键词：
Academic Medical Centers Affect African American Anxiety Behavior Behavioral Breast Breast Cancer Detection Breast Cancer Early Detection Breast Cancer Prevention Breast Cancer Risk Factor Cancer Burden Categories Cessation of life Clinical Consult Data Disclosure Early Diagnosis Education Electronic Health Record Enrollment Ensure Ethnic Origin Family Future Genetic Predisposition to Disease Health Insurance Hispanics Image Immigrant Individual Insurance Coverage Intervention Interview Knowledge Laws Lead Legal Longitudinal Studies Magnetic Resonance Imaging Mammary Ultrasonography Mammographic Density Mammographic screening Mammography Medical Methods Minority Modality Monitor Motivation New York Notification Participant Physicians Population Population Heterogeneity Prospective Studies Race Recording of previous events Research Resources Rest Risk Risk Assessment Statutes and Laws Subgroup Testing Time Tissues Visit Woman Women Status Work advanced breast cancer aged base breast cancer diagnosis breast density breast imaging cancer health disparity cancer prevention clinically relevant cohort coping experience falls follow-up health disparity high risk information seeking behavior low socioeconomic status malignant breast neoplasm patient population patient screening psychologic psychological outcomes psychosocial public health relevance racial and ethnic racial disparity racial diversity racial minority radiologist recruit response screening screening guidelines social disadvantage social disparities socioeconomics study population theories young woman

项目摘要

DESCRIPTION (provided by applicant): High mammographic breast density (MBD) reduces the sensitivity of mammography for early detection of breast cancer (BC), and is a strong predictor of BC risk. To date, 24 states, including New York, have passed legislations mandating that all women with high MBD receive written notification that informs them about the lower sensitivity of mammography and higher BC risk associated with dense breasts, and advises them to consult their physicians about risk assessment and screening; > 40% of U.S. women fall into categories of high MBD that require this notification. The legislation may worsen breast cancer health disparities, as: 1) any benefits gained from the law rests on individual women's actions and minority and low socioeconomic status women with more limited resources (e.g., less education, health insurance coverage, and coping resources) may be less able to understand and act on this information, and 2) the law does not provide for additional financial or clinical support for women with high MBD. Thus, the law may prove less beneficial in promoting BC screening in minority and low socioeconomic women, and may ultimately exacerbate disparities in BC early detection and survival. We propose a prospective study to examine the impact of breast density notification on psychological responses and subsequent screening behaviors of a racially and socioeconomically diverse study population. Drawing on our large and diverse screening patient population in Upper Manhattan, we will collect interview data on relevant constructs, informed by the Protection Motivation Theory, from 1000 women, aged 40-60 years, at the time of clinical mammography visits (baseline), and at 1-month and 12-months post- baseline. Separately, we will use electronic health records to monitor the use of subsequent mammography and supplemental breast imaging tests in the study population for up to 30 months following baseline. Defining MBD notification status as women with high MBD who receive breast density notification vs. women with low MBD who do not receive breast density notification, the aims of this study are to 1) Examine the associations of MBD notification status with general and breast cancer-specific psychological outcomes (e.g., worry, anxiety, perceived risk, response efficacy), and information seeking behavior at baseline, and at 1 month and 12 months post baseline; 2) Examine the associations of MBD notification status with participation in subsequent mammography and in supplemental imaging screening (breast ultrasound, MRI) within 30 months of the baseline; 3) Examine differences in the associations of MBD notification status with psychological outcomes, information seeking behavior and breast cancer screening behavior by race/ethnicity and educational attainment. This research will provide essential and timely data on how legislative actions that increase disclosure of clinically relevant data can affect population level cancer prevention and health disparities, and will inform future intervention planning and clinical delivery of personal breast density data in low socioeconomic and racially minority patient populations.

描述（由适用提供）：高乳房X线摄影乳腺密度（MBD）降低了乳房X线摄影对乳腺癌（BC）（BC）的敏感性，并且是BC风险的有力预测指标。迄今为止，包括纽约在内的24个州已经通过了法律，要求所有MBD高的妇女收到书面通知，以告知她们乳房X线摄影的较低敏感性以及与密集乳房相关的较高的BC风险，并建议她们就风险评估和筛查咨询医生； > 40％的美国妇女属于需要此通知的高MBD类别。该立法的乳腺癌健康分配可能更糟，如：1）从法律中获得的任何好处都取决于妇女的行为和少数群体以及低资源的社会经济地位妇女的资源更有限（例如，更少的教育，健康保险和应对资源）可能不太能够理解和对此信息采取行动；这就是法律可能证明在促进少数群体和低社会经济妇女中的卑诗省筛查方面有利，并且最终可能会加剧卑诗省早期发现和生存的分布。我们提出了一项前瞻性研究，以研究乳房密度通知对种族和社会经济多样性研究人群的心理反应以及随后的筛查行为的影响。利用我们在曼哈顿上层的大型筛查患者人群，我们将收集有关相关结构的访谈数据，该数据由保护动机理论所告知，在临床乳房X线摄影访问时（基线），在1个月和12个月后，从1000名40-60岁的女性（40-60岁）收集了访谈。另外，我们将使用电子健康记录来监测研究人群中随后的乳房X线摄影和补充乳房成像测试的使用，直到基线后长达30个月。将MBD通知状态定义为具有高MBD的女性，她们接收乳房密度通知与未接收乳房密度通知的低MBD的女性，本研究的目的是1）检查MBD通知的关联具有一般和乳腺癌特异性心理结局的状态（例如，忧虑，焦虑，感知的风险，反应效率）以及基线后的1个月和12个月在基线时寻求行为； 2）检查MBD通知状态与参与后续乳房X线摄影和补充成像筛查（乳房超声，MRI）的关联； 3）检查MBD通知状况与心理成果的关联，寻求行为的信息和乳腺癌筛查行为的差异。这项研究将提供有关立法行动如何增加临床披露的基本数据相关数据可能会影响人口水平的预防癌症和健康差异，并将告知在低社会经济和大约少数族裔患者人群中，未来的干预计划和个人乳房密度数据的临床交付。