COMPASS collaborative research Strand 3: Research into practice: implementing a complex psychoeducational intervention to promote early presentation in older women with breast cancer

Women over 70 have poorer breast cancer survival than younger women, largely due to later stage at diagnosis. Promoting early presentation (PEP) in women attending for final round of breast screening may reduce stage cost-effectively, and is unlikely to lead to overdiagnosis. We tested the radiographer-delivered PEP Intervention to promote early presentation by increasing breast cancer awareness in a randomised controlled trial. Delivered in a positive, motivational way, the intervention aims to equip older women with the knowledge, motivation and skills to present promptly to primary care with breast symptoms. In the trial, research radiographers delivered the intervention in a separate room after the mammogram, requiring considerable service reconfiguration. Training was intensive, and ongoing quality assurance involved performance feedback on videorecordings of interventions. At 2 years, the PEP Intervention increased the proportion of women breast cancer aware compared with usual care four-fold. The NHS Breast Screening Programme has now commissioned its implementation in three breast screening services. Early piloting showed that reconfiguring the service as extensively as in the trial was not sustainable. The training deterred some radiographers, and storing videorecordings for ongoing quality assurance was not feasible. We have, therefore, developed a shorter version of the PEP Intervention, delivered in the mammography room. Training is less intensive, and ongoing quality assurance will consist of direct observations and coaching as necessary. We will now measure feasibility of implementation and the effect on breast cancer awareness in routine practice. If implemented across the whole programme, the PEP Intervention has the potential to reduce avoidable deaths from delayed presentation in older women.