Understanding the Influence of Hormone Therapy on Breast Cancer Risk and Screening through Mixed Methods

Medical College Of Wisconsin, Milwaukee WI

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Abstract

Over 5% of adult Americans take hormone therapy (HT), and this number is increasing with time. HT may be taken by individuals who have pre-mature gonadal failure, those who have their gonads removed for malignant or benign conditions, females after they undergo menopause, older males, and in younger populations for desired physical changes. While HT can provide both physical and psychosocial health improvements, it is unclear how HT may influence breast cancer (BC) risk or BC treatment, with the exception of post-menopausal females who take estrogen +/- progesterone. These knowledge gaps prevent informed decision-making among healthcare providers and people considering HT, likely contributing to disparate BC screening rates and BC outcomes observed in persons on HT. The overarching goal of my research agenda is to develop evidence-based BC screening guidelines for persons on HT and this proposal fills this critical knowledge gap. This award will establish a BC screening program for adults on HT and utilize a mixed methods approach to explore perceptions towards BC risk, screening barriers, and methods to optimize BC screening. These data will provide the necessary foundation to develop a multi-institutional longitudinal BC screening cohort study of individuals on HT which will inform the development of BC screening guidelines and best practices for BC screening for individuals on HT. The foundational K08 work will be accomplished through three specific aims: 1) determine the callback and biopsy rates after screening mammography and automated breast ultrasonography in people on HT, 2) assess perceptions towards BC risk, screening, and the screening experience of people on HT through surveys and interviews, and 3) identify individual and systems-level barriers to BC screening to optimize the BC screening process through interviews and focus groups. These findings will provide the first-ever prospective scientific data on screening mammography and automated breast ultrasonography lesion detection in people on HT. The qualitative data from Aims 2 and 3 will identify individual and systems-level barriers to BC screening and opportunities to improve the BC screening process and experience for patients. The research proposal is complemented by a comprehensive and distinctive training plan focused on mixed methods and survey research, database development, and cohort recruitment and retention. In combination with my committed and collaborative mentorship team, this study and training plan is designed to optimize my seamless transition to becoming an independently funded surgeon–scientist and my efforts to optimize BC screening through a 3-step process. The novel BC screening study (Step 1) will provide the necessary preliminary data and experience to submit an R01 application to develop a multi-institutional longitudinal screening program for individuals on HT (Step 2) to definitively establish the lifetime risk of BC in response to HT to inform the development of evidence-based BC screening guidelines for persons on HT (Step 3).