Improving Utilization of Supplemental Breast MRI Screening for Women With Extremely Dense Breasts

Abramson Cancer Center at Penn Medicine

Status: Completed

Conditions: Breast Cancer

Treatments: Behavioral: Provider nudge; Behavioral: Patient nudge

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05787249

852666

UPCC 03123

P50CA244690 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The goal of this study is to increase MRI utilization among women with extremely dense breasts. The main question it seeks to answer is whether nudging of the provider, patient, or both increases the uptake of MRI among this group, and whether this effect differs between Black and White women.

Full description

Women with dense breasts have 3-5-fold increased risk for breast cancer as women without dense breasts. Dense breast tissue can "mask" small tumors, leading to reduced mammography sensitivity. Recent randomized controlled trials demonstrate that supplemental breast MRI screening improves detection of small, invasive cancers that are not detected by mammography. In January 2022, a Pennsylvania law went into effect mandating insurance coverage of supplemental screening for women with extremely dense breasts. Currently only a small fraction of eligible women with extremely dense breasts are receiving supplemental breast MRI screening. Clinical pathways to identify patients who are eligible for insurance coverage of supplemental breast MRI screening and communicate this option to patients and providers are needed to ensure equitable access to supplemental screening. This study therefore proposes a stepped wedge cluster randomized clinical trial to determine whether electronic health record (EHR) and secure text message nudges increase utilization of supplemental breast MRI screening among eligible women with extremely dense breasts.

Enrollment: 1,358 patients

Sex: Female

Ages: 40 to 74 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Patient participants:

Inclusion Criteria:

• Women aged 40-74
• Recent non-actionable mammogram of less than 6 months
• Mammogram performed at Penn Center for Advanced Medicine, Penn Presbyterian Hospital, Pennsylvania Hospital, or Radnor
• Valid mobile phone number

Exclusion Criteria:

• Prior history of breast cancer
• No breast MRI within the past 2 years
• No prior actionable mammogram within 6 months
• No recent or concurrent ultrasound

Provider participants:

Inclusion Criteria:

• Provider needs to have ordered the initial screening mammogram
• Employed by Penn Health System and access to Penn Chart

Trial design

Primary purpose: Screening

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: None (Open label)

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1,358 participants in 4 patient groups

Usual care (no nudge)

No Intervention group

Description:

Usual standard of care, no nudging.

Provider nudge only

Experimental group

Description:

Nudge sent to provider through EHR.

Treatment:

Behavioral: Provider nudge

Patient nudge only

Experimental group

Description:

Nudge sent to the patient through text messaging.

Treatment:

Behavioral: Patient nudge

Patient and provider nudge

Experimental group

Description:

Nudge sent to both provider through EHR, and to patient through text messaging.

Treatment:

Behavioral: Patient nudge

Behavioral: Provider nudge