Abstract B085: Increasing utilization of breast cancer risk assessment tools: Identifying and adapting implementation strategies using multiple stakeholder groups
Authors: Selove Rebecca , Spalluto Lucy , Sanderson Maureen , Ernst Laura , Audet Carolyn 
Published: February 2024

Background: Each year ~12,000 female breast cancers are diagnosed in US women ages 18-45 with overrepresentation of aggressive cancers, advanced stage disease at diagnosis, and inferior outcomes. The American College of Radiology and American Society of Breast Surgeons recommend that breast cancer risk assessment (RA) start no later than age 30 to identify high-risk individuals in whom to initiate screening earlier. However, RA tools are currently utilized in as few as 3-26% of eligible women. Methods: Our study aims are to assess feasibility, reach, acceptability, and appropriateness of customized strategies to increase uptake of breast cancer RA. We identified barriers to increasing utilization of RA tools through discussions with long-term community partners in the Tennessee Breast and Cervical Cancer Screening Program (TBCSP), a three-phase adapted Feasibility of Intervention Measure (FIM) in five health clinics, and one-on-one interviews guided by the Consolidated Framework for Implementation Research with 24 providers in public health settings and 37 interviews guided by the Health Belief Model with Black women age 30-50 years with no personal history of breast cancer. Interview data contributed to the development of a conceptual framework to depict influences of provider behavior in the utilization of breast cancer risk assessment. Using the CFIR-ERIC Matching Tool and working with the study’s Community Advisory Board (CAB), the research team identified three potential strategies to increase the use of breast cancer RA in public health settings. Findings: Selected strategies included having a site champion for each clinic, offering a short series of education modules, and distributing print educational materials including a provider education sheet and patient-facing information cards. These strategies were further revised in collaboration with the CAB and patients and providers in Community Engagement Studios. Implications for D&I Research: This project demonstrates the contributions of a long-standing relationship with a state-wide public health agency, implementation science tools, and collaboration with community advisors for identifying and addressing barriers to breast cancer RA. The study has generated replicable scripts for educating providers and community-informed reproducible patient education materials to increase breast cancer RA. Evaluation of the impact of these strategies on provider behavior in six clinical settings is currently underway.

Citation Format: Rebecca Selove, Lucy Spalluto, Maureen Sanderson, Laura Ernst, Carolyn Audet. Increasing utilization of breast cancer risk assessment tools: Identifying and adapting implementation strategies using multiple stakeholder groups [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr B085.