Female childhood cancer survivors who were treated with chest radiotherapy (RT) are advised to undergo annual mammography and breast magnetic resonance imaging (MRI) because of an increased risk for breast cancer, although methods to promote such screening are not well established. The randomized, controlled EMPOWER study investigated a screening intervention using mailing and brief motivational telephone interviews to promote breast cancer screening in women in the United States and Canada. The researchers presented the study at the ASCO Annual Meeting.  

Female cancer survivors from the Childhood Cancer Survivor Study (CCSS) who were treated with chest RT ≥ 20 Gy, aged 25–49 years, and had not received a mammogram in the previous two years were eligible for study inclusion. The researchers tested an intervention of general health information provided by mail followed by heart health telephone interview and compared the outcomes with a control group receiving usual care. 

Patients (N = 204) were randomized 2:1 to receive the tailored intervention (TI; n = 136) or attention control group (AC; n = 68). The patients had a mean age of 35.8 years and were stratified based on age at enrollment (25–39 years versus 40 years or older) and race/ethnicity.  

The study’s primary outcome was change in the proportion of patients completing a mammogram within 12 months, and the secondary outcome was change in the proportion of women receiving a surveillance MRI within 12 months.  

Women in the TI group were significantly more likely to report a surveillance mammogram within the following 12 months (33.1%; n = 45) compared with those in the AC cohort (17.6%; n = 12; relative risk [RR] = 1.7; 95% confidence interval [CI] = 1–2.9; p = 0.02). However, the proportion of women receiving surveillance MRI was similar between the TI and AC groups (16.8% versus 13.2%, respectively; RR = 1.2; 95% CI = 0.6–2.5; p = 0.58).  

Among those in the TI group, reasons indicated as barriers to obtaining mammography were 

  • Putting it off (27%) 
  • Cost (25%) 
  • Doctor did not order it (23%) 
  • Have not had any issue (22%). 

The researchers concluded, “The use of mailed tailored materials followed by telephone-delivered counseling increased mammography surveillance rates in female survivors at high-risk for breast cancer. However, this approach did not significantly increase the rate of breast MRI. Cost and physician ordering were important barriers that may be addressed in future studies.”