A trial looking at ways to encourage older women to report breast symptoms

Cancer type:

Breast cancer

Status:

Results

Phase:

Phase 3

This trial tested a new way of encouraging older women to report breast symptoms promptly to their GP. This trial was part of a project called the ‘Promoting Early Presentation Project’ (PEP for short). This trial was supported by Cancer Research UK.

In the UK, the NHS Breast Screening Programme routinely invites all women between 50 and 70 for breast screening every 3 years. The Government is planning to expand the breast screening programme to cover women between 47 and 73 by 2012.

If you are older, you still have the right to have 3 yearly mammograms. But you need to ask your GP or local unit to arrange this, as you will not be routinely invited.

All women are at risk of developing breast cancer. In fact, older women are more at risk of developing breast cancer than younger women.

The long term aim of this study was to test a way of encouraging older women to go to their GP promptly if they have breast symptoms, so that if they are found to have breast cancer, they can start treatment quickly and improve the chances of it being successful.

In the first part of the PEP Project, the researchers developed a way of

Increasing women’s awareness of breast cancer risk and symptoms
Encouraging them to know what their breasts normally look and feel like
Increasing their confidence and motivation to visit their GP if they notice any changes

The researchers call this ‘an intervention’. It involves having a discussion with a radiographer Open a glossary item , and a booklet that the woman can take home with her.

In the second part of the PEP Project, the researchers found that the women who received the intervention had better breast cancer awareness 6 months later.

This information is about the third stage of the PEP project which measured the effect that either the booklet alone or the booklet and discussion together had on breast cancer awareness in older women a year later.

Summary of results

The researchers found that the intervention raised breast cancer awareness in older women.

The trial recruited 867 women between the ages of 67 and 70 who were having their final routine appointment in the NHS Breast Screening Programme. The women were put into 1 of 3 groups. Neither the women nor the breast screening service staff could decide which group they were in. This is called randomisation.

Some of the women had a 10 minute discussion with a radiographer and were given a booklet
Some of the women were just given a booklet
Some of the women had a routine appointment (usual care) without any extra intervention

Women having usual care were told that they would no longer be invited for routine screening, but could request it, and were given contact details to do this.

The booklet contained information about breast cancer including

Breast cancer symptoms
The risk of breast cancer for older women
How to spot a change in the breast
The benefits of seeing their doctor promptly if they find any breast changes

The 10 minute discussion involved a radiographer giving the same messages as in the booklet and showing pictures of breast changes. She also demonstrated how to check the breast and was able to answer any questions and talk through what the woman might do on finding a breast change.

The researchers measured the women’s breast cancer awareness after 1 month and 1 year. They did this by sending them questionnaires to complete. The questionnaires included questions about breast cancer symptoms, breast cancer risk at different ages, and also asked how often the women checked their breasts.

More than 8 out of 10 of the women taking part completed the questionnaires after 1 month and 1 year. The results showed that

After a month, the women who had either the discussion and booklet, or just the booklet, had a better awareness of breast cancer symptoms and risk than women who had usual care
This was best for the women who had both the booklet and the discussion
Women who had both the discussion and the booklet also reported checking their breasts more, but there was no difference in how often women checked their breasts between those who just had the booklet and those who had usual care
After a year, the increased awareness of symptoms and risk in women who had either the booklet or booklet and discussion was still seen, but the difference in how often women checked their breasts was not

The researchers concluded that, compared with usual care, the intervention increased breast cancer awareness 1 month later. It also increased awareness a year later, but less so. In this trial, having the booklet and discussion was better than the booklet alone.

The researchers hope that having more understanding of symptoms and risk, skills to check their breasts, and confidence and motivation to visit their doctor will mean that older women go to their doctors sooner if they notice a change in their breast. They will need to carry out further studies to see if this does happen.

We have based this summary on information from the team who ran the trial. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item ) and published in a medical journal. The figures we quote above were provided by the trial team. We have not analysed the data ourselves.