IMPROVED SCREENING FOR BREAST-CANCER ASSOCIATED WITH A TELEPHONE-BASED RISK ASSESSMENT

Background. Our objective was to develop and field-test a telephone-ba sed breast cancer risk assessment and to assess its efficacy in improv ing screening behavior. The study was performed at a financial institu tion and a manufacturing corporation with main offices in Boston, Mass achusetts, and branch offices in various regions of the United States. Methods. A longitudinal study consisting of an initial health risk as sessment administered by telephone, with a subsequent follow-up study initiated 8 months later, was performed. Study design was influenced b y some of the suggestions made by the benefits departments of the corp orate sponsors. A voice-response, telephone system collected risk info rmation from callers and gave real-time risk assessment. These callers could receive a risk assessment over the phone and remain completely anonymous or furnish name and address to receive a more detailed writt en report. Main outcome measures included the response rate and demogr aphics of the respondents, risk profiles of the callers, and breast ca ncer screening statuses. Results. There were 343 participants of whom 189 relinquished anonymity to receive more detailed information by mai l and were available for a follow-up study. Sixty-three women (18%) re ported a family history of breast cancer, with 34 women (10%) respondi ng that one first-degree blood relative had been diagnosed before the age of 50. A strong positive correlation between the level of familial risk, and the decision to remain anonymous existed (P < 0.0001). Ther e was an increase in compliance with breast self-examination from 34% (40/119) at time of use of the system to 62% (74/119) at follow-up, P < 0.0001. Clinical breast exams showed similar improvements, from 82 ( 98/119) to 92% (110/119), P < 0.0137. Paired and unpaired data of wome n 40 years of age and older indicate an improvement in mammography com pliance from time of system use to follow-up, 76 (22/29) to 93% (27/29 ), P < 0.0572, and 79 (33/42) to 93% (27/29), P < 0.0129, respectively . Conclusions. A population of women with a risk profile higher than t hat of the U.S. population called the survey. System use is associated with an improvement in breast cancer screening habits. Self-reported, increased genetic risk for breast cancer was strongly correlated with a decision to remain anonymous. (C) 1998 American Health Foundation a nd Academic Press.