Personalized breast cancer risk assessments at primary care up patients’ odds of mammography use

Providing patients with individualized breast cancer risk assessments during primary care visits increases their odds of attending annual mammography screening appointments, according to new research in JAMA Network Open.

Black women shoulder a disproportionate share of deaths from the disease, with regular access to screening one of the factors. Wanting to close this gap, Chicago providers experimented with sharing cancer risk assessments as part of routine checkups. The practice appears to be paying off, as mammography rates among women at high risk was significantly higher after the intervention, leaping from nearly 37% up to 51%.

“The findings of this study suggest that providing individualized breast cancer risk estimates as a standard component of preventive healthcare may reduce racial inequities in breast cancer screening and ultimately mitigate disparities in breast cancer mortality,” Candice Schwartz, MD, with the division of hematology and oncology at the University of Illinois at Chicago, and co-authors wrote Friday.

For their prospective study (conducted from 2013-2014), women ages 25-69 received risk estimates utilizing a validated tool, while investigators tracked their mammography use in the 18 months that followed. Nearly 350 women enrolled and 188 were eligible for the analysis, at an average age of almost 51. About 37% were Latina, 61% non-Hispanic Black, and 2% other racial and ethnic groups. About 52% had an average risk of developing the disease, and the other 48% were deemed high-risk for breast cancer. Schwartz et al. noted a “nonsignificant” increase in the screening rate (from 39% up to 49%) after implementing the risk assessment. However, among high-risk women, the change was significantly higher, they noted, at about 14 percentage points.

The study is limited by several factors, including the fact that all women in the analysis had insurance. Investigators also did not gauge health literacy, and the results would need to be confirmed settings other than federally qualified health centers.

“This approach warrants further study as a strategy to reduce racial disparities in breast cancer mortality, although further research should combine BCRA with other interventions that may improve mammography adherence to maximize the benefit,” authors cautioned.