Impact of a risk based breast screening decision aid on understanding, acceptance and decision making

Abstract Internationally, population breast cancer screening is moving towards a risk-stratified approach and requires engagement and acceptance from current and future screening clients. A decision aid ( www.defineau.org ) was developed based on women’s views, values, and knowledge regarding risk-stratified breast cancer screening. This study aims to evaluate the impact of the decision aid on women’s knowledge, risk perception, acceptance of risk assessment and change of screening frequency, and decision-making. Here we report the results of a pre and post-survey in which women who are clients of BreastScreen Victoria were invited to complete an online questionnaire before and after viewing the decision aid. 3200 potential participants were invited, 242 responded with 127 participants completing both surveys. After reviewing the decision aid there was a significant change in knowledge, acceptance of risk-stratified breast cancer screening and of decreased frequency screening for lower risk. High levels of acceptance of risk stratification, genetic testing and broad support for tailored screening persisted pre and post review. The DEFINE decision aid has a positive impact on acceptance of lower frequency screening, a major barrier to the success of a risk-stratified program and may contribute to facilitating change to the population breast screening program in Australia

A novel ecological momentary assessment app for the investigation of daily cognitive functioning in breast cancer survivors: A feasibility study

Purpose: Breast cancer survivors often experience cancer-related cognitive impairment (CRCI), such as problems with memory and attention. However, typical neuropsychological test batteries are unable to capture the day-to-day variability of cognition and may be underestimating CRCI. The present study aims to assess the feasibility, usability, and validity of a novel ecological momentary assessment (EMA) app of cognition. Methods: Nineteen breast cancer survivors 6–36-months post-chemotherapy and 26 healthy controls completed the NIH Toolbox Cognition Battery. Subsequently, participants completed the EMA app (once a day, for 30 days) comprising four cognitive tasks assessing processing speed, working memory, inhibition, and attention. At the conclusion of the app, participants completed a usability questionnaire on which content analysis was performed. Feasibility was assessed against eight criteria, including accessibility, app compliance and technical smoothness. Convergent construct validity was assessed using Spearman's correlation analyses between the NIH toolbox and the EMA app. Results: Five of eight feasibility criteria were met, including: accessibility, app motivation, participation rate, drop-out, and data collection. Additionally, our content analyses revealed four themes important to usability: self-development, altruism, engagement, and functionality. Majority of the EMA tasks were moderately positively correlated with the corresponding constructs of the NIH toolbox tasks (R’s range: 0.55-0.64), indicating, better performance on the EMA app coincided with better performance on the NIH toolbox. Conclusions: Our findings show the app was accessible, participants were motivated to complete sessions and our tasks showed good construct validity. Our novel EMA app can be used as a comprehensive cognitive measure in cancer survivors

Management of early node‐positive breast cancer in Australia: A multicentre study

To examine practice patterns for breast cancer patients with limited sentinel node (SN) disease in light of the ACOSOG Z0011 results. Retrospective analysis of patients with T1‐2 breast cancer and positive sentinel lymph node biopsy (SLNB) admitted between January 2009 and December 2012. Patient demographics, tumor characteristics, and treatments were recorded. Eight hundred positive SLNBs were identified. A total of 452 (56.5%) proceeded to completion axillary lymph node dissection (cALND). cALND rate decreased from 65.1% to 49.7% from 2009–2010 to 2011–2012. cALND was performed for micrometastasis or isolated tumor cells in 39.3% in 2009–2010 and 22.2% in 2011–2012, whereas for macrometastases the rates were 83.1% and 68.6%, respectively. cALND rates diminished for both Z0011‐eligible and ‐ineligible patients. The ACOSOG Z0011 trial presentation and publication coincided with a reduction in cALND for breast cancer with limited nodal disease. There appears equipoise regarding management of macrometastatic SN disease