Enhancing the public health benefits of mammography screening by informing women of both breast cancer and breast arterial calcification results: A randomized trial to promote cardiovascular health

在癌症预防领域，乳房X光检查是最成功的癌症筛查工具之一。美国今年将有3700万女性接受乳房X光检查，之后，这些女性将收到一封信，让她们知道自己是否有乳腺癌的证据。最近的研究表明，标准数字乳房X光照相还产生了对妇女健康至关重要的额外信息；即关于乳动脉内是否存在钙化的信息--乳动脉钙化(BAC)。BAC的存在与冠状动脉内钙化有关，而钙化是冠状动脉疾病(CAD)的标志。研究表明，至少12.7%的女性乳房X光检查显示出BAC--约八分之一。在BAC患者中，32%-96%患有CAD。因此，保守地说，乳房X光检查每年可以检测到超过150万例CAD。尽管这对公众健康有潜在的好处，但在乳房X光检查后的信中，BAC信息并没有直接传达给患者。未能告知BAC状态是错失了告知女性冠心病风险的机会，而且与患者的喜好不一致。这项建议的目的是调查向女性乳房X光检查后提供BAC信息是否会影响她们的心血管健康行为。我们将把影像显示BAC(N=1,889，英语和西班牙语)的乳房X光检查患者随机分为以下两组：a)BAC增强Letter条件，告知女性其BAC阳性结果和BAC-CAD协会，鼓励女性寻求预防性心脏病治疗，并提供心脏病转诊信息；或b)等待名单控制条件，患者最初会收到标准的BAC检查信函，并在6个月后了解她们的BAC状况。我们假设，收到BAC增强信函的女性将更有可能参加心血管健康预约(主要结果)，参与心脏健康行为，并进行冠心病检测。在常识模型的指导下，我们试图了解哪些心理因素在干预和结果之间的关系中起中介作用。此外，大多数BAC流行文献都是在以白人为主的样本上进行的。为了纠正这一点，我们将在一个大的、不同种族和民族的样本中描述BAC的流行情况(N=14,875)。创新：这将是第一项以“直接对消费者”的方式与接受乳房X光检查的女性直接分享BAC信息的干预研究，也是第一次在不同种族和民族的样本中报告BAC患病率的研究。公共卫生影响：该项目是确保妇女直接受益于乳房X光检查可以产生的所有丰富健康数据的第一步。

Breast mammography is one of the most successful cancer screening tools in the cancer prevention arsenal. 37 million women in the US will receive a mammogram this year, and following that, these women will receive a letter letting them know whether they do or do not have evidence of breast cancer. Recent research indicates that standard digital mammography also yields additional information critical to women’s health; that is, information about the presence of calcifications within breast arteries - breast arterial calcification (BAC). The presence of BAC has been associated with calcification within coronary arteries, which is a marker of coronary artery disease (CAD). Research indicates that at least 12.7% of women’s mammograms reveal BAC – about 1 in 8. Of those with BAC, 32%-96% have CAD. Thus, conservatively, mammography could detect over 1.5 million cases of CAD each year. Despite this potential public health boon, BAC information is not directly communicated to patients in the post-mammography letter. The failure to communicate BAC status is a missed opportunity to inform women about CAD risk, and is inconsistent with patient preferences. The goal of this proposal is to investigate whether provision of BAC information to women post-mammography influences their cardiovascular health behaviors. We will randomize mammography patients whose imaging reveals BAC (N=1,889, English and Spanish-speaking) to either: a) the BAC-Enhanced letter condition which informs women about their positive BAC findings and the BAC-CAD association, encourages women to seek preventive cardiology care, and provides cardiology referral information; or b) the Waitlist Control condition, where patients receive a standard mammography letter initially and learn their BAC status 6 months later. We hypothesize that women who receive the BAC-Enhanced letter will be more likely to attend a cardiovascular health appointment (primary outcome), engage in heart healthy behavior, and have CAD detected. Guided by the Common Sense Model, we seek to understand which psychological factors mediate the relationship between the intervention and the outcomes. Also, most BAC prevalence literature has been conducted on predominantly white samples. To remedy this, we will describe BAC prevalence in a large, racially and ethnically diverse sample (N=14,875). Innovation: This will be the first study of an intervention to directly share BAC information with women undergoing mammography in a “direct to consumer” approach, and the first to report BAC prevalence in a racially and ethnically diverse sample. Public health impact: The project is a first step towards ensuring that women benefit directly from all of the rich health data that mammography can yield.