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（由申请人提供）：高乳房 X 光检查乳腺密度 (MBD) 会降低乳房 X 光检查早期检测乳腺癌 (BC) 的敏感性，并且是 BC 风险的有力预测因子。迄今为止，包括纽约在内的 24 个州已通过该标准。立法要求所有患有高 MBD 的女性收到书面通知，告知她们乳房 X 光检查的敏感性较低以及与致密乳房相关的 BC 风险较高，并建议她们就风险评估和筛查咨询医生； 40% 的美国女性属于需要此通知的高 MBD 类别，该立法可能会加剧乳腺癌健康差异，因为：1）从该法律中获得的任何好处都取决于女性个人的行动，而少数族裔和社会地位较低的女性则更为有限。资源（例如，较少的教育、健康保险覆盖和应对资源）可能不太能够理解这些信息并采取行动，并且 2）法律没有为患有高 MBD 的女性提供额外的财务或临床支持。法律可能证明对促进少数族裔和低社会经济女性的 BC 筛查不太有益，并可能最终加剧 BC 早期发现和生存的差异。我们提出一项前瞻性研究，以检验乳腺密度通知对不同种族的心理反应和后续筛查行为的影响。利用我们在曼哈顿上城的庞大且多样化的筛查患者群体，我们将根据保护动机理论，从临床时 1000 名年龄在 40-60 岁的女性中收集有关相关结构的访谈数据。乳房X光检查就诊（基线），并在基线后 1 个月和 12 个月，我们将分别使用电子健康记录来监测研究人群在基线后长达 30 个月的后续乳房 X 光检查和补充乳腺成像测试的使用情况。 MBD 通知状态作为收到乳腺密度通知的高 MBD 女性与未收到乳腺密度通知的低 MBD 女性，本研究的目的是 1) 检查 MBD 通知的关联状态与一般和乳腺癌特定的心理结果（例如担忧、焦虑、感知风险、反应效果）以及基线时以及基线后 1 个月和 12 个月的信息寻求行为；2) 检查 MBD 通知状态的关联；基线后 30 个月内参与后续乳房 X 光检查和补充影像筛查（乳腺超声、MRI）；3) 通过以下方式检查 MBD 通知状态与心理结果、信息寻求行为和乳腺癌筛查行为之间的关联差异；这项研究将提供关于如何增加临床信息披露的立法行动的重要且及时的数据。相关数据可以影响人口水平的癌症预防和健康差异，并将提供信息未来的干预计划和在低社会经济和少数种族患者群体中个人乳腺密度数据的临床交付。