Supporting informed decisions about breast cancer screening in communities with known environmental contamination: a
Mia St Angelo1, Megan E Romano2,3, Lisa Gallagher2
1The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Dr, WTRB Level 5, Lebanon, NH, 03766, USA.
Purpose:
This study tested the impact of a breast cancer screening decision aid (DA) that was adapted to include environmental risk information.
Methods:
This was a pre-post study in communities with known per- and poly-fluoroalkyl substances (PFAS) contamination. Participants were 100 women ages 39-49, with no history of breast cancer and no mammogram in the past year. Participants completed a baseline survey, used the DA, then completed a final survey. Baseline surveys measured demographics, PFAS exposure, and PFAS-related risk perceptions. Paired pre-post survey measures included breast cancer risk perceptions, screening knowledge, decisional conflict, and screening intentions.
Results:
Mean age of participants was 43 years; most non-Hispanic white (97%); 43% resided in micropolitan, small town, or rural areas. Potential PFAS exposure included private well use for 35%; 19% had tested their water for PFAS contamination; 54% used a home water filter. While most (62%) did not experience PFAS-related stress, 27% felt stress about family well-being, and 25% often/constantly worried about the health effects of PFAS in the prior month. Pre-DA, 29% felt likely that they would develop breast cancer in the next 10 years, versus 19% post-DA. Median knowledge scores increased from 8 to 10 out of 10 before and after DA use. Intentions to get a mammogram in the next year slightly decreased from 85 to 78%.
Conclusion:
Use of a DA incorporating information about environmental risk information reduced perceptions of breast cancer risk and improved knowledge and decisional conflict about breast cancer screening among women living in PFAS-contaminated communities.
Clinical Trial Registration:
NCT06098118.
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