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

NCT ID: NCT05787249

Last Updated: 2026-01-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1358 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-10-04

Study Completion Date

2025-04-04

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

SCREENING

Blinding Strategy

NONE

Study Groups

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Usual care (no nudge)

Usual standard of care, no nudging.

Group Type NO_INTERVENTION

No interventions assigned to this group

Provider nudge only

Nudge sent to provider through EHR.

Group Type EXPERIMENTAL

Provider nudge

Intervention Type BEHAVIORAL

Nudge directed to the provider with the aim of increasing ordering of MRI in patients with extremely dense breasts

Patient nudge only

Nudge sent to the patient through text messaging.

Group Type EXPERIMENTAL

Patient nudge

Intervention Type BEHAVIORAL

Nudge directed to the patient with the aim of increasing the uptake of MRI in patients with extremely dense breasts

Patient and provider nudge

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

Group Type EXPERIMENTAL

Patient nudge

Intervention Type BEHAVIORAL

Nudge directed to the patient with the aim of increasing the uptake of MRI in patients with extremely dense breasts

Provider nudge

Intervention Type BEHAVIORAL

Nudge directed to the provider with the aim of increasing ordering of MRI in patients with extremely dense breasts

Interventions

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Patient nudge

Nudge directed to the patient with the aim of increasing the uptake of MRI in patients with extremely dense breasts

Intervention Type BEHAVIORAL

Provider nudge

Nudge directed to the provider with the aim of increasing ordering of MRI in patients with extremely dense breasts

Intervention Type BEHAVIORAL

Eligibility Criteria

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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


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

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:
Minimum Eligible Age

40 Years

Maximum Eligible Age

74 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Abramson Cancer Center at Penn Medicine

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Anne Marie McCarthy, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Pennsylvania

Locations

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University of Pennsylvania

Bala-Cynwyd, Pennsylvania, United States

Site Status

Countries

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United States

References

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Pettersson A, Graff RE, Ursin G, Santos Silva ID, McCormack V, Baglietto L, Vachon C, Bakker MF, Giles GG, Chia KS, Czene K, Eriksson L, Hall P, Hartman M, Warren RM, Hislop G, Chiarelli AM, Hopper JL, Krishnan K, Li J, Li Q, Pagano I, Rosner BA, Wong CS, Scott C, Stone J, Maskarinec G, Boyd NF, van Gils CH, Tamimi RM. Mammographic density phenotypes and risk of breast cancer: a meta-analysis. J Natl Cancer Inst. 2014 May 10;106(5):dju078. doi: 10.1093/jnci/dju078.

Reference Type BACKGROUND
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Bond-Smith D, Stone J. Methodological Challenges and Updated Findings from a Meta-analysis of the Association between Mammographic Density and Breast Cancer. Cancer Epidemiol Biomarkers Prev. 2019 Jan;28(1):22-31. doi: 10.1158/1055-9965.EPI-17-1175. Epub 2018 Sep 11.

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Weinstein SP, Korhonen K, Cirelli C, Schnall MD, McDonald ES, Pantel AR, Zuckerman S, Borthakur A, Conant EF. Abbreviated Breast Magnetic Resonance Imaging for Supplemental Screening of Women With Dense Breasts and Average Risk. J Clin Oncol. 2020 Nov 20;38(33):3874-3882. doi: 10.1200/JCO.19.02198. Epub 2020 Sep 15.

Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 34794600 (View on PubMed)

Wolf, Tom. "Insurance Company Law of 1921 - Coverage for Mammographic Examinations." The Office Website for the Pennsylvania General Assembly, Pennsylvania General Assembly, 2020, https://www.legis.state.pa.us/cfdocs/legis/li/uconsCheck.cfm?yr=2020&sessInd=0&act=52.

Reference Type BACKGROUND

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type DERIVED
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Other Identifiers

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P50CA244690

Identifier Type: NIH

Identifier Source: secondary_id

View Link

852666

Identifier Type: REGISTRY

Identifier Source: secondary_id

UPCC 03123

Identifier Type: -

Identifier Source: org_study_id

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