%0 Journal Article
%T Promoting Early Presentation of Breast Cancer in Older Women: Implementing an Evidence-Based Intervention in Routine Clinical Practice
%A Lindsay J. L. Forbes
%A Alice S. Forster
%A Rachael H. Dodd
%A Lorraine Tucker
%A Rachel Laming
%A Sarah Sellars
%A Julietta Patnick
%A Amanda J. Ramirez
%J Journal of Cancer Epidemiology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/835167
%X Background. Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women. Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis. After examining efficacy in a randomised controlled trial, we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms, as an integral part of the final invited mammogram at age ~70, in the English National Health Service Breast Screening Programme. Methods. We trained mammographers, who then offered the intervention to older women in four breast screening services. We examined breast cancer awareness at baseline and one month in women receiving the intervention, and also in a service where the intervention was not offered. Results. We trained 27 mammographers to deliver the intervention confidently to a high standard. Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service (odds ratio 15.2, 95% confidence interval 10.0 to 23.2). Conclusions. The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a randomised controlled trial. It has the potential to reduce delay in diagnosis for breast cancer in older women. 1. Introduction Older women with breast cancer have poorer one-year relative survival than younger women [1] and are more likely to be diagnosed with advanced stage of disease [2]. Older age is a risk factor for delay in presentation in breast cancer [3]. Women over the age of 73 are not routinely invited for screening on the English National Health Service (NHS) Breast Screening Programme; most women with breast cancer of this age group therefore present symptomatically. We have developed a brief intervention to promote early symptomatic presentation of breast cancer in older women (the Promoting Early Presentation (PEP) Intervention) [4]. It is a scripted one-to-one intervention, delivered to an older woman in a positive, collaborative, and motivational style by a health professional, providing the knowledge, motivation, confidence, and skills to present promptly on discovering a breast symptom. It is supported by a booklet which women are given to take home. The PEP Intervention increased breast cancer awareness fourfold compared with usual care for up to two years in a randomised controlled trial, in which it was delivered by research health professionals [5, 6], and the effect was sustained
%U http://www.hindawi.com/journals/jce/2012/835167/