Condition category
Date applied
Date assigned
Last edited
Retrospectively registered
Overall trial status
Recruitment status
No longer recruiting

Contact information



Primary contact

Dr Lindsay Forbes


Contact details

Guy's Campus
9th Floor
Capital House
42 Weston Street
United Kingdom
+44 (0)20 7848 6216

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Improving older women's knowledge and confidence to present early with breast symptoms: a randomised controlled trial of a radiographer-delivered intervention


PEP (Promoting Early Presentation)

Study hypothesis

The supplementation of optimised usual care with one of two variants of a radiographer-delivered psycho-education intervention will be more effective than optimised usual care alone in improving women's knowledge and confidence to present promptly with breast symptoms.

Review of the evidence available in

Ethics approval

King's College Hospital Research Ethics Committee, 18/04/2007, ref: 07/Q0703/51

Study design

Three-arm multicentre randomised controlled trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use the contact details to request a patient information sheet


Breast cancer


All three groups will receive optimised usual care, i.e., a reminder that they are no longer eligible for routine breast screening but may continue to request further breast screening themselves every three years. One group in addition will receive a radiographer-delivered booklet containing educational messages designed to increase women's knowledge and confidence to detect breast changes and to motivate them to present promptly if they discover a breast change. The third group will receive a 10-minute radiographer-delivered interview in addition to the booklet. The interview is based on the key messages of the booklet and provides the opportunity for the radiographer to reinforce and clarify the content of the booklet.

The intervention is given just once, duration 10 - 15 minutes for the interview group, 5 minutes or less for booklet-alone and optimised usual care. Follow up consists of a questionnaire sent at 1 month and another at 6 months post-intervention for all groups.

Intervention type



Not Specified

Drug names

Primary outcome measure

Breast awareness, measured one month post-intervention, based on a composite measure of knowledge of non-lump breast cancer symptoms, knowledge of age-related relative risk and confidence to detect a breast change: each component (knowledge/risk/confidence) is given equal weighting and contributes one point to the total score (range 0 to 3), as follows:
1. Non-lump knowledge:
1.1. Score 1 if 5 - 9 symptoms identified
1.2. Score 0 if 0 - 4 symptoms identified
2. Relative risk:
2.1. Score 1 if identify old age group as most at risk
2.2. Score 0 if do not identify old age group as most at risk
3. Confidence:
3.1. Score 1 if check breasts at least once a week/month
3.2. Score 0 if check breasts at least once every six months or less

Secondary outcome measures

Secondary measures are changes at one month and six months post intervention in:
1. Knowledge of breast cancer symptoms (score 0 - 11)
2. Knowledge of relative risk (in the next year who is most likely to get breast cancer? [response categories: a 30 year old woman/a 50 year old woman/a 70 year old woman/a woman of any age])
3. Knowledge of absolute risk (how many women will develop breast cancer in their lifetime? [response categories: 1 in 3/1 in 9/1 in 100/1 in 1000])
4. Confidence to detect a breast change (how often do you check your breasts? [response categories: at least once a week/at least once a month/at least every six months/rarely or never])
5. Breast awareness, measured six months post intervention, based on a composite measure of knowledge of non-lump breast cancer symptoms, knowledge of age-related relative risk, and confidence to detect a breast change

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

Women aged 67 - 70 years attending National Health Service (NHS) breast screening clinics for final routine mammography

Participant type


Age group




Target number of participants


Participant exclusion criteria

1. Any significant disease or disorder that affects ability to consent or participate
2. Insufficient understanding of the English language, or language difficulties
3. Participant going overseas during the six-month study period

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

Guy's Campus
United Kingdom

Sponsor information


Institute of Psychiatry (UK)

Sponsor details

King's College London
De Crespigny Park
United Kingdom
+44 (0)20 7848 0675

Sponsor type




Funder type


Funder name

Cancer Research UK (CRUK) (UK)

Alternative name(s)


Funding Body Type

private sector organisation

Funding Body Subtype

other non-profit


United Kingdom

Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Basic results (scientific)

Publication list

2009 results in:
2011 results in:
2017 results in:

Publication citations

  1. Results

    Linsell L, Forbes LJ, Kapari M, Burgess C, Omar L, Tucker L, Ramirez AJ, A randomised controlled trial of an intervention to promote early presentation of breast cancer in older women: effect on breast cancer awareness., Br. J. Cancer, 2009, 101 Suppl 2, S40-8, doi: 10.1038/sj.bjc.6605389.

  2. Results

    Forbes LJ, Linsell L, Atkins L, Burgess C, Tucker L, Omar L, Ramirez AJ, A promoting early presentation intervention increases breast cancer awareness in older women after 2 years: a randomised controlled trial., Br. J. Cancer, 2011, 105, 1, 18-21, doi: 10.1038/bjc.2011.205.

Additional files

Editorial Notes

07/06/2017: Publication reference added.