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

项目1 BRAVE策略（乳腺癌风险评估，实现公平）

• 批准号: 10705092
• 负责人: Maureen Sanderson
• 金额: $ 5.6万
• 依托单位: MEHARRY MEDICAL COLLEGE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-26 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10705092
• 关键词: Address; Administrator; Adoption; Age; Age Years; BRCA1 Mutation; BRCA2 Mutation; Breast Cancer Detection; Breast Cancer Early Detection; Breast Cancer Risk Assessment Tool; Breast Cancer Risk Factor; Cancer Center; Cervical Cancer Screening; Clinic; Clinical; Communities; Consolidated Framework for Implementation Research; Data; Data Collection; Diagnosis; Disease; Disparity; Education; Eligibility Determination; Equity; Feedback; Funding; Future; Geography; Goals; Guidelines; Health; Health Services Accessibility; High Risk Woman; Inferior; Infrastructure; Interview; Life; Location; Low Income Population; Malignant Neoplasms; Mammographic screening; Measures; Medical Care Team; Methods; Minority; Outcome; Patients; Phenotype; Population; Population Heterogeneity; Positioning Attribute; Proctor framework; Provider; Public Health; Race; Recommendation; Research Design; Risk; Risk Assessment; Site; Surveys; Tennessee; Testing; The Vanderbilt-Ingram Cancer Center at the Vanderbilt University; Translating; Tumor Biology; Underserved Population; United States; Universities; Woman; Women Status; Work; age group; aged; cancer care; cancer diagnosis; cancer health disparity; clinical care; clinical practice; early screening; ethnic diversity; evidence base; high risk; high risk population; implementation evaluation; implementation outcomes; implementation strategy; improved; improved outcome; low socioeconomic status; malignant breast neoplasm; medical schools; member; mortality; mortality disparity; novel; primary outcome; programs; racial diversity; racial minority population; randomized, clinical trials; risk stratification; rural area; rural dwellers; safety net; screening; screening program; secondary outcome; socioeconomics; study population; supplemental screening; uptake; young woman

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.

项目摘要：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、诊断时处于晚期疾病和较差的结果被认为是过多的 在这个年轻女性群体中。此外，年轻女性的乳腺癌死亡率差异导致 居住在农村地区、社会经济地位低下的妇女过早死亡的情况增多， 以及来自少数族裔群体的人。获得护理、诊断和治疗的延误以及差异 肿瘤生物学部分解释了这些差异。从种族、地理和社会经济角度进行识别 乳腺癌高风险的多样化年轻女性提供了减少癌症差异的机会 通过早期筛查和发现乳腺癌。整合现有乳腺癌风险的利用 评估（RA）工具融入临床护理是识别这些年轻女性的一种手段。 虽然建议所有女性不晚于 30 岁接受 RA，但这尚未转化为临床实践 因此，女性在 50 岁之前不会接受 RA，而建议对 50 岁以下的女性进行筛查。 平均风险。相比之下，高危女性应在 25 岁时就开始筛查（例如，对于那些已确定 具有 BRCA1 或 BRCA2 突变）。由于大多数 25-49 岁的女性现在没有接受 RA，并且 这些女性的乳腺癌在晚期呈现出与劣势相关的更具侵袭性的表型 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并被认定为高危人群，可以在50岁之前进行筛查，以便及早诊断癌症 阶段，此时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风险 通过测试在州级公众中实施基于证据的乳腺癌 RA 的策略来了解癌症差异 为不同种族和族裔的低收入妇女群体提供服务的健康计划。勇敢研究 旨在评估所选定制策略的可行性、影响范围、可接受性和适当性 增加乳腺癌 RA 的摄取。我们将通过进行一种新颖的阶梯式楔子来实现这些目标 采用混合方法研究设计的试验。主要结果是 25-49 岁女性的比例 患有风湿性关节炎。次要结果包括女性人数：1）被确定为高风险； 2）追求风险—— 坚持筛选； 3) 诊断患有乳腺癌。实施成果包括影响范围、可行性、 可接受性和适当性。收集的数据将为未来的多中心集群随机临床试验提供信息 在较长时间内更大规模地测试实施策略，丰富服务不足的地区 少数民族和农村居民等人口。