Project 1 BRAVE Strategy (Breast cancer Risk Assessment, achieVing Equity)

项目总结：完整项目1 在美国，每年约有12000名年龄在18-45岁之间的女性被诊断出患有乳腺癌。 过度表现为侵袭性癌症、确诊时的晚期疾病和较差的预后。 在这群年轻女性中。此外，年轻女性的乳腺癌死亡率差异导致 社会经济地位低的妇女、居住在农村地区的妇女早期死亡增加， 以及那些来自少数族裔群体的人。获得护理的机会、诊断和治疗的延误以及 肿瘤生物学部分解释了这些差异。在种族、地理和社会经济上的认同 乳腺癌高危年轻女性的多样化为减少癌症差异提供了机会 通过对乳腺癌的早期筛查和检测。综合利用现有的乳腺癌风险 临床护理中的评估(RA)工具是识别这些年轻女性的一种手段。 虽然建议不晚于30岁的所有女性使用RA，但尚未将其转化为临床实践 因此，女性在50岁之前不会接受RA治疗，而50岁以下的女性建议进行筛查 平均风险。相比之下，高危女性应该早在25岁时就开始筛查(例如，对于那些被确认的人 有BRCA1或BRCA2突变)。由于大多数25-49岁的妇女现在不接受RA治疗，并且 这些女性的乳腺癌在晚期表现为更具侵袭性的表型，与低度 结果，应该为这一年龄组的类风湿关节炎制定实施战略。如果25-49岁的女性收到 RA和RA被确定为高危人群，他们可以在50岁之前进行筛查，以便更早地诊断癌症 疾病治疗最成功的阶段。 乳腺癌风险评估：实现公平(BRAGE)研究的中心目标是减少乳房 通过在州级公众中测试实施循证乳腺癌RA的策略来实现癌症差异 为不同种族和民族的低收入妇女群体提供服务的健康计划。勇敢的学习 旨在评估选定的定制策略的可行性、覆盖范围、可接受性和适当性 增加乳腺癌RA的摄取率。我们将通过进行一种新颖的、阶梯式的楔子来实现这些目标 试验采用混合方法研究设计。主要结果是年龄在25-49岁之间的女性比例 患有类风湿性关节炎。次要结果包括妇女的数量：1)被确定为高风险；2)追求风险- 坚持筛查；3)诊断为乳腺癌。实施成果包括覆盖范围、可行性、 可接受性和适当性。收集的数据将为未来的多部位集群随机临床试验提供依据 在更长的时间内更大范围地测试实施战略，丰富服务不足的实施战略 少数民族和农村居民等人口。

PROJECT SUMMARY: FULL PROJECT 1 Each year ~12,000 women ages 18-45 are diagnosed with breast cancer in the United States (US). Overrepresentation of aggressive cancers, advanced stage disease at diagnosis, and inferior outcomes are seen in this population of young women. Further, breast cancer mortality disparities in young women result in increased early loss of life amongst women from low socioeconomic status (SES), those dwelling in rural areas, and those from racial minority groups. Access to care, delays in diagnosis and treatment, and differences in tumor biology partially explain these disparities. Identifying racially, geographically, and socioeconomically diverse young women at high risk for breast cancer offers an opportunity to reduce cancer disparities through early screening and detection of breast cancer. Integrating the use of existing breast cancer risk assessment (RA) tools into clinical care is a means to identify these young women. While RA is recommended for all women no later than age 30, this has not yet been translated to clinical practice and thus women are not receiving RA prior to the age of 50 years when screening is recommended for those at average risk. Women at high risk, in contrast, should start screening as young as age 25 (e.g., for those identified to have a BRCA1 or BRCA2 mutation). As most women ages 25-49 years of age do not now receive RA, and breast cancer in these women presents with a more aggressive phenotype at later stage associated with inferior outcomes, implementation strategies for RA in this age group should be developed. If women ages 25-49 receive RA and are identified as high-risk, they can be screened earlier than age 50 to diagnose cancer at an earlier stage, when the disease is most successfully treated. The central goal of the Breast cancer Risk Assessment: achieVing Equity (BRAVE) study is to reduce breast cancer disparities by testing strategies to implement evidence-based breast cancer RA in a state-level public health program that serves a racially and ethnically diverse population of low-income women. The BRAVE study aims to assess the feasibility, reach, acceptability, and appropriateness of select customized strategies to increase uptake of breast cancer RA. We will achieve these aims through conducting a novel, stepped-wedge trial employing a mixed methods study design. The primary outcome is the proportion of women aged 25-49 having RA. Secondary outcomes include the numbers of women: 1) identified as high-risk; 2) pursuing risk- adherent screening; and 3) diagnosed with breast cancer. Implementation outcomes include reach, feasibility, acceptability, and appropriateness. Data collected will inform a future multi-site cluster randomized clinical trial to test the implementation strategies on a larger scale over a longer duration, enriched for underserved populations such as minority and rural dwellers.