Intervention to Promote Breast Cancer Surveillance in Childhood Cancer Survivors Who Received Chest Radiotherapy


Key Points

  • The intervention increased the proportion of women receiving screening mammography within 12 months.
  • No significant increase in the use of breast MRI was observed.

In the EMPOWER trial, which took place within the larger Childhood Cancer Survivor Study (CCSS) and was reported in the Journal of Clinical Oncology, Oeffinger et al found that an intervention consisting of mailed educational materials followed by telephone-delivered counseling led to an increased use of screening mammography among survivors who had received chest radiotherapy for childhood cancer. The use of screening magnetic resonance imaging (MRI) was not increased.

The open-label study included 204 female survivors in the CCSS aged 25 to 50 years who had received chest radiotherapy with ≥ 20 Gy for childhood disease and had received no breast imaging in the past 24 months. They were randomly assigned 2:1 to receive a mailed informational packet followed by a tailored, 30- to 45-minute telephone-delivered motivational interview (n = 136) or an attention control (n = 68). The intervention group received material providing information on breast cancer risk, recommendations for screening, and information cards for the patient and her primary care physician. The attention control group received the same number of contacts, but the mailed information and telephone calls focused on cardiac health. The primary outcome measure was the proportion of participants who completed a screening mammogram by 12 months on intent-to-treat analysis.

Screening Rates and Barriers

A total of 45 women (33.1%) in the intervention group completed a screening mammogram within 12 months vs 12 (17.6%) in the control group (relative risk [RR] = 1.9, P = .018), with the intervention having a significant impact among women aged 25 to 39 years (RR = 2.2, 95% confidence interval [CI] = 1.1–4.7) but not among those aged 40 to 50 years (RR = 1.4, 95% CI = 0.6–3.2). The proportion of women who reported undergoing breast MRI at 12 months was 16.2% vs 13.2% (RR = 1.2, 95% CI = 0.6–2.5).

Among women in the intervention group aged 25 to 39 years, the reported primary barriers to completing a mammogram were “put it off” (36.0%), “too expensive” (34.3%), and “doctor didn’t order it” (29.4%); among those aged 40 to 50 years, primary barriers were “too busy” (50.0%), “haven’t had any problems” (46.7%), “put it off” (43.8%), “doctor didn’t order it” (37.5%), and “too expensive” (37.5%). Reported barriers to completing a breast MRI were similar.

The investigators concluded, “Use of mailed materials followed by telephone-delivered counseling increased mammography screening rates in survivors at high risk for breast cancer; however, this approach did not increase the rate of breast MRI. Cost of imaging and physician recommendation were important barriers that should be addressed in future studies.”

Kevin C. Oeffinger, MD, of Duke Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by National Cancer Institute grants, Meg Berté Owen Foundation, and American Lebanese-Syrian Associated Charities. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.