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What is the best way for healthcare professionals to communicate changes in estimated risk of breast cancer?


Project Description

Risk estimation models for common multifactorial diseases such as breast cancer are often used, e.g. in Family History Clinics to inform decisions about prevention options. A challenge for the use of these risk estimation models in clinical practice is that an individual’s risk estimate can change. For example, these models can include more information sources, namely information about breast density and Single Nucleotide Polymorphisms (SNPs).

The extent of change can be large. In the Family History Risk (FH-Risk) study, 914 Manchester-based women received risk estimates between 1993-2010. They were told their risk was “high”, “moderate”, “average” or “below average”; women at high or moderate risk were offered prevention options, i.e. enhanced screening or chemoprevention. A sub-sample of 106 women had their risks re-evaluated using the latest version of the Tyrer-Cuzick model, including mammographic density and 18 SNPs. Of these 106 women, the lifetime risk of 66 women changed by one or more risk categories (e.g. from high to moderate), whilst only 40 women did not change category.

There is a dearth of research exploring the impact of receiving revised risk estimates for any disease. Whilst there appears to be little emotional impact of receiving breast cancer risk estimates, many people do not trust the estimates they received (5). Receiving revised risk estimates may further undermine trust in healthcare professionals or credibility of risk estimation, as changes may produce revised management plans.

This PhD will: (a) identify the key issues for women who receive revised risk estimates; (b) develop materials to support consultations involving revised risk estimates, and (c) assess emotional impact, understanding of risk information, trust in healthcare professionals, and women’s views of prevention options.. his research will produce an evidence base to help healthcare professionals communicate better with women about changes in estimated breast cancer risk.

Training/techniques to be provided:
The student will become part of the multidisciplinary NIHR BRC Cancer Prevention and Early Detection theme (lead Evans) Together the supervisory team have considerable experience of working together on implementation of cancer prevention/ early detection.

French will provide expertise on qualitative methods, systematic reviewing and psychological aspects of cancer screening/ early detection. Evans will provide expertise on clinical aspects of cancer prevention and early detection, and on risk estimation models.

The student will be based within the Manchester Centre for Health Psychology, the largest group of health psychologists in Europe.

Entry Requirements:
Candidates should hold (or be about to obtain) a minimum upper second class honours degree in psychology or another relevant discipline. They should also hold a master degree in health psychology or similar subject, or have relevant research experience.

Funding Notes

Applications are invited from self-funded students. This project has a Band 2 fee. Details of our different fee bands can be found on our website (View Website). For information on how to apply for this project, please visit the Faculty of Biology, Medicine and Health Doctoral Academy website (View Website).

As an equal opportunities institution we welcome applicants from all sections of the community regardless of gender, ethnicity, disability, sexual orientation and transgender status. All appointments are made on merit.

References

1. French DP, Cameron E, Benton JS, Deaton C, & Harvie M. Can communicating personalised disease risk promote healthy behaviour change? A systematic review of systematic reviews. Ann Behav Med 2017; 51: 718-729.

2. French, DP Southworth J, Howell A, Harvie M, Stavrinos P, Watterson D, Evans DG, & Gorman LS. Psychological impact of providing women with personalized ten-year breast cancer risk estimates. Br J Cancer 2018; 118: 1648-1657.

3. van Veen EM, Brentnall AR, Byers H, Harkness EF, Astley SM, Sampson S, Howell A, Newman WG, Cuzick J, & Evans DGR. Use of Single-Nucleotide Polymorphisms and Mammographic Density Plus Classic Risk Factors for Breast Cancer Risk Prediction. JAMA Oncol. 2018 Apr 1; 4(4):476-482.

4. Long H, Brooks J, Harvie M, Maxwell A, & French DP. How do women experience a false positive test result from breast screening? A systematic review and thematic synthesis. Br J Cancer 2019; 129; 351-358.

5. Brentnall AR, van Veen EM, Harkness EF, Rafiq S, Byers H, Astley SM, Sampson S, Howell A, Newman WG, Cuzick J, Evans DGR. A case-control evaluation of 143 single nucleotide polymorphisms for breast cancer risk stratification with classical factors and mammographic density. Int J Cancer. 2019 Jun 28. doi: 10.1002/ijc.32541. [Epub ahead of print]

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