• Mara A Schonberg, Roger B Davis, Maria C Karamourtopoulos, Adlin Pinheiro, Scot B Sternberg, Alicia R Jacobson, Gianna M Aliberti, Tejas S Mehta, Jennifer L Cluett, Marc L Cohen, Tobie Atlas, and Nadine M Tung.
• Division of General Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: mschonbe@bidmc.harvard.edu.
• Am J Prev Med. 2020 Sep 1; 59 (3): 343-354.

IntroductionGuidelines recommend individualized breast cancer screening and prevention interventions for women in their 40s. Yet, few primary care clinicians assess breast cancer risk.Study DesignPretest-Posttest trial.Setting/ParticipantsWomen aged 40-49 years were recruited from one large Boston-based academic primary care practice between July 2017 and April 2019.InterventionParticipants completed a pretest, received a personalized breast cancer risk report, saw their primary care clinician, and completed a posttest.Main Outcome MeasuresUsing mixed effects models, changes in screening intentions (0-100 scale [0=will not screen to 100=will screen]), mammography knowledge, decisional conflict, and receipt of screening were examined. Analyses were conducted from June 2019 to February 2020.ResultsPatient (n=337) mean age was 44.1 (SD=2.9) years, 61.4% were non-Hispanic white, and 76.6% were college graduates; 306 (90.5%) completed follow-up (203 with 5-year breast cancer risk <1.1%). Screening intentions declined from pre- to post-visit (79.3 to 68.0, p<0.0001), especially for women with 5-year risk <1.1% (77.2 to 63.3, p<0.0001), but still favored screening. In the 2 years prior, 37.6% had screening mammography compared with 41.8% over a mean 16 months follow-up (p=0.17). Mammography knowledge increased and decisional conflict declined. Eleven (3.3%) women met criteria for breast cancer prevention medications (ten discussed medications with their clinicians), 22 (6.5%) for MRI (19 discussed MRI with their clinician), and 67 (19.8%) for genetic counseling (47 discussed with the clinician).ConclusionsReceipt of a personalized breast cancer report was associated with women in their 40s making more-informed and less-conflicted mammography screening decisions and with high-risk women discussing breast cancer prevention interventions with clinicians.Trial RegistrationThis study is registered at www.clinicaltrials.govNCT03180086.Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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