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Journal of Cancer Epidemiology
Volume 2012 (2012), Article ID 835167, 6 pages
http://dx.doi.org/10.1155/2012/835167
Research Article

Promoting Early Presentation of Breast Cancer in Older Women: Implementing an Evidence-Based Intervention in Routine Clinical Practice

1Promoting Early Presentation Group, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, Capital House, 42 Weston Street, London SE1 3QD, UK
2NHS Cancer Screening Programmes, Fulwood House, Old Fulwood Road, Sheffield S10 3TH, UK

Received 31 August 2012; Accepted 10 October 2012

Academic Editor: Marjan van den Akker

Copyright © 2012 Lindsay J. L. Forbes et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women. Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis. After examining efficacy in a randomised controlled trial, we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms, as an integral part of the final invited mammogram at age ~70, in the English National Health Service Breast Screening Programme. Methods. We trained mammographers, who then offered the intervention to older women in four breast screening services. We examined breast cancer awareness at baseline and one month in women receiving the intervention, and also in a service where the intervention was not offered. Results. We trained 27 mammographers to deliver the intervention confidently to a high standard. Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service (odds ratio 15.2, 95% confidence interval 10.0 to 23.2). Conclusions. The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a randomised controlled trial. It has the potential to reduce delay in diagnosis for breast cancer in older women.