title: Promoting early presentation of breast cancer by older women: a preliminary evaluation of a one-to-one health professional-delivered intervention.
abstract: OBJECTIVE
  To test the early effects of a novel one-to-one health professional-delivered intervention designed to increase awareness and thereby promote early presentation of breast cancer among older women.
  
  
  METHODS
  Women attending their final routine appointment in the English NHS Breast Screening Programme received a booklet or a booklet supplemented by a brief interview, in addition to usual care. This was a within-group before-and-after evaluation of the two versions of the intervention. The primary outcome was change in the knowledge of breast cancer symptoms from baseline to 1 month postintervention. Secondary outcomes were knowledge of risk of developing breast cancer, confidence to detect a breast change, and likelihood of disclosure to someone close. Levels of cancer worry and any adverse effects caused by the intervention were also monitored.
  
  
  RESULTS
  One hundred seventy-six women received the booklet and 116 received the booklet-plus-interview. At 1-month postintervention, the mean number of breast cancer symptoms identified (out of 11) increased from 5.3 by 1 symptom (P<.001) in the booklet group and by 1.9 (P<.001) in the booklet-plus-interview group. Improvements were sustained at 6 months. Positive improvements were made in the knowledge of risk of developing breast cancer and the confidence to detect a breast change in both groups; however, neither version of the intervention had an impact on encouraging women to disclose to someone close immediately on discovery of a breast symptom. No adverse effects were reported, and there was no significant increase in the level of cancer worry.
  
  
  CONCLUSIONS
  Both versions of the intervention are worthy of testing in randomized trials to assess the impact on breast cancer awareness and ultimately on delayed presentation of breast cancer and mortality.
authors.affiliation: Cancer Research UK Promoting Early Presentation Group, Institute of Psychiatry/King's College London, St Thomas' Hospital, SE1 7EH London, UK. caroline.burgess@kcl.ac.uk
authors.forename: Caroline C
authors.initials: CC
authors.lastname: Burgess
authors.forename: Louise
authors.initials: L
authors.lastname: Linsell
authors.forename: Marcia
authors.initials: M
authors.lastname: Kapari
authors.forename: Lynne
authors.initials: L
authors.lastname: Omar
authors.forename: Michael
authors.initials: M
authors.lastname: Michell
authors.forename: Patsy
authors.initials: P
authors.lastname: Whelehan
authors.forename: Michael A
authors.initials: MA
authors.lastname: Richards
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Ramirez
mesh_terms: D000367:Age Factors; D000368:Aged; D001364:Awareness; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology*; D016504:Breast Self-Examination; D003131:Combined Modality Therapy; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D010174:Pamphlets; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires