BRAVE Strategy (Breast cancer Risk Assessment: achieVing Equity in breast cancer outcomes – strategy for the public health setting)
Lucy B. Spalluto, MD MPH
Maureen Sanderson, PhD, MPH
Rebecca Selove, PhD, MPH
Each year ~12,000 women ages 18-45 are diagnosed with breast cancer in the United States (US). Overrepresentation of aggressive cancers, advanced stage disease at diagnosis, and inferior outcomes are seen in this population of young women. Further, breast cancer mortality disparities in young women result in increased early loss of life amongst women from low socioeconomic status (SES), those dwelling in rural areas, and those from racial minority groups. Access to care, delays in diagnosis and treatment, and differences in tumor biology partially explain these disparities. Identifying racially, geographically, and socioeconomically diverse young women at high risk for breast cancer offers an opportunity to reduce cancer disparities through early screening and detection of breast cancer. Integrating the use of existing breast cancer risk assessment (RA) tools into clinical care is a means to identify these young women. The central goal of the Breast cancer Risk Assessment: achieVing Equity (BRAVE) study is to reduce breast cancer disparities by testing strategies to implement evidence-based breast cancer RA in a state-level public health program that serves a racially and ethnically diverse population of low-income women. The BRAVE study aims to assess the feasibility, reach, acceptability, and appropriateness of select customized strategies to increase uptake of breast cancer RA. We will achieve these aims through conducting a novel, stepped-wedge trial employing a mixed methods study design. The primary outcome is the proportion of women aged 25-49 having RA. Secondary outcomes include the numbers of women: 1) identified as high-risk; 2) pursuing risk-adherent screening; and 3) diagnosed with breast cancer. Implementation outcomes include reach, feasibility, acceptability, and appropriateness. Data collected will inform a future multi-site cluster randomized clinical trial to test the implementation strategies on a larger scale over a longer duration, enriched for underserved populations such as minority and rural dwellers.
1) Assess the Feasibility to Implement and Integrate Strategies for Breast Cancer RA in the Public Health Setting Together with Community Partners.
2) Conduct a Stepped-Wedge Trial to Evaluate the Impact of Breast Cancer RA Implementation Strategies on the Proportion of Eligible Women Receiving RA (reach).
3) Evaluate Acceptability and Appropriateness of the Selected Strategies to Increase Uptake of Breast Cancer RA.