Cancer Disparity Collaborative Supplement: Integrating electronic health record and patient-generated health data for breast cancer and cardiovascular disease risk assessment among diverse multiet...

Oregon Health & Science University, Portland OR

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Abstract

PROJECT SUMMARY/ABSRACT This supplement is being submitted in response to PAR-22-114 to conduct an ancillary study to SWOG 1904, a multicenter randomized controlled trial of chemoprevention decision support among women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS). Our overall objective is to develop an equitable and efficient approach for risk assessment of breast cancer and atherosclerotic cardiovascular disease (ASCVD). Women with high-risk breast lesions, such as AH or LCIS, have up to a 4- to 10-fold increased risk of invasive breast cancer compared to women with non-proliferative breast disease and derive a 70-80% relative breast cancer risk reduction with anti-estrogen therapy for chemoprevention. A potential barrier to chemoprevention uptake includes competing comorbidities, such as ASCVD. Racial/ethnic differences exist for multiple chronic diseases; for example, Black and Hispanic women are at lower risk for breast cancer but have poorer clinical outcomes compared to non-Hispanic Whites, but they are at higher risk for ASCVD risk factors, including hypertension, dyslipidemia, and diabetes. Current recommendations are for individuals at intermediate-high risk for ASCVD to receive cholesterol-lowering medications with statin therapy for the primary prevention of cardiovascular events. Among racially/ethnically diverse women with AH or LCIS, we found that mean 10-year risk of breast cancer was higher than ASCVD (9.14% vs. 6.69%, p<0.001); however, among women at high-risk for both conditions, uptake of statins was higher compared to anti-estrogen therapy for chemoprevention (58% vs. 21%, p<0.001). To address under-utilization of chemoprevention among women at high-risk for breast cancer, the risks and benefits of anti-estrogen therapy could be placed in the context of medications used to treat or prevent other chronic conditions, such as statins for ASCVD. We have developed a web-based RealRisks decision aid (DA), which includes personalized breast cancer risk assessment and decision support for chemoprevention. The DA is available in English and Spanish and has been rigorously tested in racially/ethnically diverse women with varying health literacy. Using Fast Healthcare Interoperability Resources (FHIR), we have developed a RealRisks user interface (UI), which allows patients to access and verify their medical records to facilitate breast cancer risk assessment. Our current aims are: 1) To conduct user evaluations in up to 24 high-risk women with AH or LCIS to develop a FHIR-enhanced RealRisks UI to assess both breast cancer and ASCVD risk by extracting clinical data from the electronic health record (EHR); 2) To assess the effect of the FHIR-enhanced RealRisks UI on patient activation, risk perceptions, and usability, in a feasibility pilot study among 55 diverse multiethnic high-risk women with AH or LCIS. This preliminary work will inform a future intervention trial through the SWOG NCORP Research Base, which may be applied to both high-risk women and breast cancer survivors. Our goal is to develop equitable strategies for risk assessment of multiple chronic diseases to improve health outcomes and reduce health disparities.