Breast cancer is the second most common cancer among U.S. women and the second leading cause of cancer death . One of the goals of the Comprehensive Cancer Control Plan for Michigan is to further “reduce the female breast cancer death rate” . This study strives to contribute to this goal, specifically for female Young Breast Cancer Survivors (YBCS) diagnosed at 20–45 years old and their female relatives who may be at increased risk.
Breast cancer survivors have a 2-fold higher risk of developing a second breast cancer, compared to women without breast cancer, matched for age, breast density, and use of mammography . In addition, unaffected first- and second-degree relatives of women diagnosed with breast cancer younger than 50 years of age have respectively a 2.3 and 1.5 increased relative risk for breast cancer . The initial step in determining an unaffected woman’s risk for breast cancer is the collection of a thorough family history that includes first- and second-degree relatives on both the maternal and paternal sides of the family . However, a review of health plan charts conducted by the Genomics Program at the Michigan Department of Community Health revealed that only 42% of charts had documented a family history of breast cancer, while, 98% of these charts did not document age of onset for the affected family members . According to national recommendations, women with a strong family history of breast cancer should be referred for genetic counseling [7, 8]. Yet, a phone survey of the general adult population living in Michigan revealed that only 12% of high-risk women older than 40 years of age actually received this service . Furthermore, only 56% of these high-risk women had a Clinical Breast Exam (CBE) in the past 12 months; only 48% had a mammogram in the past 12 months; and, only 44% had both a mammogram and CBE in the past 12 months .
The study aims to increase breast cancer surveillance and early detection by targeting YBCS identified from a state cancer registry and their high risk relatives. Specific aims are to:
Aim 1: Identify and survey 3,000 female YBCS reported to the cancer registry who were diagnosed between the ages of 20–45 years and determine: (a) their current breast cancer screening status; (b) perceived barriers and facilitators to screening; (c) willingness to participate in an intervention to increase breast cancer screening; and (d) willingness to serve as a breast cancer screening advocate for their high-risk relatives.
Aim 2: Identify and survey up to two unaffected first- and/or second-degree female relatives per YBCS and determine: (a) their current breast cancer screening status; (b) perceived barriers and facilitators to screening; and (c) willingness to participate in an intervention to increase breast cancer screening. Female relatives will be between 25–64 years and have an increased risk of breast cancer based on the YBCS’ age of diagnosis.
Aim 3: Compare the efficacy of two versions of an intervention on breast cancer screening utilization and other outcomes among YBCS and their high-risk female relatives. YBCS and their high-risk female relatives will be randomly assigned as a family unit to receive either the Targeted or the Enhanced Tailored version of the intervention. (Description of the two intervention methods follows).