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

项目概要：完整项目1 在美国，每年约有12，000名18 - 45岁的女性被诊断患有乳腺癌。 侵袭性癌症、诊断时的晚期疾病和较差的预后的比例过高， 在这群年轻女性中此外，年轻女性乳腺癌死亡率的差异导致 社会经济地位低的妇女、居住在农村地区的妇女过早死亡的人数增加， 和少数民族的人。获得保健的机会、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、地理和社会经济上识别 不同的乳腺癌高风险年轻女性提供了减少癌症差异的机会 通过早期筛查和检测乳腺癌。整合使用现有的乳腺癌风险 临床护理中的RA评估工具是识别这些年轻女性的一种手段。 虽然RA被推荐用于所有不超过30岁的女性，但这尚未转化为临床实践 因此，当建议50岁以下的妇女进行筛查时，妇女在50岁之前没有接受RA治疗。 平均风险相比之下，高风险女性应该在25岁时就开始筛查（例如，对于那些确定 BRCA1或BRCA2突变）。由于大多数年龄在25 - 49岁的妇女现在没有接受RA， 这些女性的乳腺癌在晚期表现为更具侵袭性的表型，与低分化相关。 结果，应制定该年龄组RA的实施策略。如果25 - 49岁的女性接受 RA和被确定为高风险，他们可以在50岁之前进行筛查，以在更早的时间诊断癌症。 阶段，当疾病得到最成功的治疗。 乳腺癌风险评估：实现公平（BRAVE）研究的中心目标是减少乳腺癌 通过测试策略在州一级公众中实施循证乳腺癌RA的癌症差异 为不同种族和民族的低收入妇女提供服务的保健方案。BRAVE研究 旨在评估选择定制策略的可行性、范围、可接受性和适当性， 增加乳腺癌RA摄取。我们将通过实施一种新颖的、阶梯式的楔形结构来实现这些目标。 采用混合方法研究设计的试验。主要结果是25 - 49岁妇女的比例 有RA。次要结果包括妇女人数：1）被确定为高风险; 2）追求风险- 粘附筛查;和3）诊断为乳腺癌。实施成果包括覆盖面、可行性、 可接受性和适当性。收集的数据将为未来的多中心随机分组临床试验提供信息 在更长的时间内更大规模地测试执行战略， 少数民族和农村居民。

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.