Online guide aids breast cancer prevention decisions

When women at high risk of breast cancer viewed a customized Web-based decision guide about prevention options, they were more likely to make a choice about prevention and to feel comfortable with their choice, a new study has found.

Researchers, including Mateo Banegas, a predoctoral research associate in the Public Health Sciences Division, developed an online tool called the Guide to Decide, which included general information about breast cancer and personalized information about an individual woman's five-year risk of breast cancer.

The guide walked women through two medical options to prevent breast cancer: tamoxifen and raloxifene. Information was tailored to each woman’s age and race, and included information on the benefits and risk of tamoxifen and raloxifene as well as how it would affect the woman’s breast cancer risk.

The study looked at postmenopausal women considered at high risk of breast cancer. Of the 1,012 women who participated, 690 were randomly assigned to view the decision guide. Participants were asked after viewing the guide and again three months later about whether they wanted to receive preventive treatment and how they felt about that decision.

Less uncertainty making decisions

Women who viewed the Guide to Decide reported significantly less uncertainty when deciding whether to take tamoxifen or raloxifene, and three months later they were more likely to have made a decision.

"Since the decision to use tamoxifen or raloxifene to prevent breast cancer is based on each woman's preferences with no single right or wrong answer, the intervention enabled each woman to weigh the relative risks and benefits for herself and make a decision that aligned with her own values and preferences," said first author Banegas, who is a doctoral candidate at the University of Washington and works in the Thompson Studies group. Banegas presented the findings April 14 at the annual meeting of the Society of Behavioral Medicine in New Orleans.

"Because the guide was Web-based, women could access it in the comfort of their home or preferred setting, at their own pace, and with their family, friends or other support system around. In addition, tailoring the information meant it matched each woman's circumstances and was much more personal," said senior author Dr. Angela Fagerlin of the University of Michigan Medical School.

Future research will look at how many risks and benefits can be presented to patients before they are overwhelmed by information and are not able to process it fully.

The National Institutes of Health, the National Cancer Institute Biobehavioral Cancer Prevention and Control Training Program and the National Cancer Institute Center for Hispanic Health Promotion Training Program funded the study.

[Adapted from a University of Michigan Health System news release]