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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）：高乳腺摄影乳腺密度（MBD）降低了乳腺摄影早期检测乳腺癌（BC）的灵敏度，并且是BC风险的强预测因子。到目前为止，包括纽约在内的24个州已经通过立法，要求所有患有高MBD的妇女收到书面通知，告知她们乳房X光检查的灵敏度较低，与致密乳房相关的BC风险较高，并建议她们咨询医生进行风险评估和筛查; > 40%的美国妇女属于需要这种通知的高MBD类别。这项立法可能会加剧乳腺癌健康差距，因为：1）从法律中获得的任何好处都取决于妇女个人的行动以及资源更有限的少数民族和社会经济地位低的妇女（例如，受教育程度、健康保险覆盖率和应对资源较少的妇女可能不太能够理解这些信息并根据这些信息采取行动，2）法律没有为患有高MBD的妇女提供额外的财政或临床支持。因此，该法律可能证明在促进少数民族和低社会经济地位妇女的BC筛查方面没有那么有利，并可能最终加剧BC早期发现和生存的差异。我们提出了一项前瞻性研究，以检查乳腺密度通知的心理反应和随后的筛查行为的种族和社会经济多样性的研究人群的影响。基于我们在上曼哈顿的大量且多样化的筛查患者人群，我们将在临床乳腺X线摄影访视（基线）时以及基线后1个月和12个月时，从1000名年龄为40-60岁的女性中收集基于保护动机理论的相关结构的访谈数据。另外，我们将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光检查和补充乳房成像检查的使用。将MBD通知状态定义为接受乳腺密度通知的高MBD女性与未接受乳腺密度通知的低MBD女性，本研究的目的是1）检查MBD通知的相关性具有一般和乳腺癌特异性心理结果的状态（例如，在基线时以及基线后1个月和12个月时，检查MBD通知状态与参与随后的乳房X线摄影和补充成像筛查的相关性（乳腺超声，MRI）基线30个月内; 3）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的相关性的差异，这些差异来自种族/民族和教育程度。这项研究将提供必要和及时的数据，说明如何采取立法行动，增加披露临床相关数据可以影响人口水平的癌症预防和健康差异，并将为未来的干预计划和临床交付的个人乳腺密度数据在低社会经济和种族少数患者人群。