Telfort J, Trivedi MS, Yi HS, Colbeth H, Vanegas A, Vargas J, Sandoval R, Wood J, Dimond J, Finkelstein J, Kukafka R, Crew KD. Implementing decision support for breast cancer chemoprevention in primary care. J Clin Oncol. 2017 May;35(15 Suppl):e13038. doi: 10.1200/JCO.2017.35.15_suppl.e13038

BACKGROUND: Breast cancer risk assessment and chemoprevention with anti-estrogens among high-risk women are underutilized. We developed web-based decision support tools for high-risk women, RealRisks, and their primary care providers (PCPs), BNAV, which are integrated into clinic workflow.

METHODS: We conducted a pilot study in 50 women who were found to have a 5-year risk of invasive breast cancer ≥1.67% according to the Gail model during screening mammography. RealRisks includes modules on breast cancer risk and chemoprevention, as well as interactive games to communicate risk and preference elicitation for chemoprevention. A tailored patient and provider action plan is generated summarizing their breast cancer risk profile. Before and after interacting with RealRisks, participants completed validated questionnaires on breast cancer and chemoprevention knowledge and chemoprevention intention. Prior to their next clinic visit, their PCPs were given access to the BNAV reference toolbox. High-risk referrals and chemoprevention uptake were assessed by medical chart review. Paired t-tests and chi-square tests were used to analyze continuous and categorical variables pre/post-intervention, respectively.

RESULTS: From Mar to Aug 2016, 50 high-risk women were enrolled and 40 were evaluable. Median age 64.5 years (range, 49-72); white/black/Hispanic (%): 37.5/25/37.5; 35% had adequate health literacy; median 5-year breast cancer risk was 2.2% (range, 1.7-3.9). Before and after interacting with RealRisks, we observed an increase in adequate breast cancer knowledge (60% vs. 84%, p = .01) and chemoprevention knowledge (5% vs. 25%, p < .01). After viewing RealRisks, 30% of women were interested in taking an anti-estrogen for chemoprevention, 33% not interested, and 37% unsure. Thus far, only 2 were referred for high-risk consultations and no high-risk women initiated chemoprevention.

Despite increased interest in chemoprevention after exposure to RealRisks, additional barriers to chemoprevention uptake exist, including competing comorbidities and time constraints during the clinical encounter. Targeting younger women with higher breast cancer risk may increase chemoprevention uptake.

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