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Trial registered on ANZCTR
Registration number
ACTRN12624000873527p
Ethics application status
Submitted, not yet approved
Date submitted
19/06/2024
Date registered
17/07/2024
Date last updated
17/07/2024
Date data sharing statement initially provided
17/07/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
The CASSOWARY (CAncer genomic riSk ScOres in primARY Care) Trial
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Scientific title
The CASSOWARY (CAncer genomic riSk ScOres in primARY Care) Trial: a randomised controlled trial of the clinical utility and cost-effectiveness of a multi-cancer polygenic risk score in general practice
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Secondary ID [1]
310857
0
N/A
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Universal Trial Number (UTN)
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Trial acronym
The CASSOWARY Trial
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Cancer
331894
0
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Condition category
Condition code
Cancer
328623
328623
0
0
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Bowel - Back passage (rectum) or large bowel (colon)
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Cancer
328624
328624
0
0
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Breast
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Cancer
328625
328625
0
0
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Prostate
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Cancer
328626
328626
0
0
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Malignant melanoma
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The intervention is a ‘complex intervention’ and contains several components. The main component is a polygenic risk score, with a post-test consultation (approximately 30 minutes in duration) to discuss the participant's personal risk of melanoma, colorectal, breast and prostate cancer with an associated risk report for the participant and their GP.
Participants will attend an appointment (approximately 30 minutes) with a trained researcher to complete consent, collect demographic details and complete a baseline questionnaire regarding family history of cancer and cancer screening activities.
Participants in the intervention group will provide a DNA sample using a saliva kit. They will receive the results of the polygenic risk score during a consultation with a research 3-4 weeks later. A polygenic risk score for each cancer will be generated from the presence or absence of each of the SNPs (consisting of those known to be associated with risk of the relevant cancer), using the most up-to-date relative risks of cancer for each DNA variant and the individual’s family history of cancer. Applying Australian age-sex incidence data, a 10-year absolute risk of each cancer will be calculated. Screening recommendations will be generated to correspond to NHMRC-endorsed national guidelines for each cancer. No participant will be recommended less screening than the current NHMRC-endorsed national guidelines. The reports are designed to alter screening and referral behaviours, with details for how participants can action their recommendations (e.g. contact details for BreastScreen Victoria to book a mammogram). Approximately 10% of these consultations will be audio recorded (involving participants who confirmed their consent to being audio recorded in their trial consent form) for quality control purposes.
A print-out report summarising the participant’s cancer risks and screening recommendations will be given to the participant and their GP to discuss. The GP will, as required, organise appropriate cancer screening. The risk report is designed to increase response efficacy for screening; a person’s belief that the behaviour will reduce their disease risk.
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Intervention code [1]
327274
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Early detection / Screening
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Intervention code [2]
327275
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Prevention
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Intervention code [3]
327276
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Behaviour
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Comparator / control treatment
Participants randomised to the control group will receive an attention control brochure regarding ways to reduce their risk of cancer and during a consultation with a researcher. This brochure is based on the Cancer Council Victoria 2022 '7 ways to help prevent cancer' document.
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Control group
Active
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Outcomes
Primary outcome [1]
336424
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The rate of risk-appropriate screening behaviours for colorectal, melanoma, breast and prostate cancer. The numerator is the count of risk-appropriate screening behaviours which were due and completed within 12 months post-delivery of the intervention or attention control and the denominator is the number of participants in each group.
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Assessment method [1]
336424
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Risk-appropriate screening will be defined by the method of risk assessment in each trial group (i.e. based on usual care (age and family history) in controls and polygenic risk scores (incorporating genomic data, age, sex and family history) in the intervention group. An individual could have up to three screening behaviours to perform correlated to the three cancers evaluated for each individual, giving a total value of 0 to 3 for each participant. Data will be collected from participant self report, general practice medical records and administrative datasets; Medicare billing of cancer screening, National Bowel Cancer Screening Program, BreastScreen Victoria and the Victorian Admitted Episodes Dataset.
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Timepoint [1]
336424
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12 months post delivery of the intervention or attention control
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Secondary outcome [1]
436785
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Impact of the intervention on over-screening: either an inappropriate test (e.g., colonoscopy in someone at average risk of colorectal cancer), commencing screening younger than recommended (e.g., PSA in a man in his forties at average risk of prostate cancer), or too frequent screening (e.g., annual mammograms in an average risk woman)
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Assessment method [1]
436785
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Evaluation of participant self-report, GP medical record (location of recruitment) and external data sources (Medicare, BreastScreen Victoria, National Bowel Cancer Screening Program, Victorian Admitted Episodes Dataset).
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Timepoint [1]
436785
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12 months post-delivery of the intervention or attention control
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Secondary outcome [2]
436787
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Perceived risk personal of colorectal cancer (absolute and comparative)
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Assessment method [2]
436787
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Participant reported percentage risk
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Timepoint [2]
436787
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [3]
436789
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Perceived risk personal of melanoma (absolute and comparative)
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Assessment method [3]
436789
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Participant reported percentage risk
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Timepoint [3]
436789
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [4]
436791
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(Biologically female participants only) Perceived risk personal of breast cancer (absolute and comparative)
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Assessment method [4]
436791
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Participant reported percentage risk
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Timepoint [4]
436791
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [5]
436792
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(Biologically male participants only) Perceived risk personal of prostate cancer (absolute and comparative)
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Assessment method [5]
436792
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Participant reported percentage risk
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Timepoint [5]
436792
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [6]
436794
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(Intervention participants only) Psychosocial impact of the genomic test result
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Assessment method [6]
436794
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The Feelings About genomiC Testing Results (FACToR) Questionnaire (Li et al., 2019)
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Timepoint [6]
436794
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1 month following delivery of the trial intervention
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Secondary outcome [7]
436795
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Cancer-specific anxiety
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Assessment method [7]
436795
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Cancer Worry Scale (Lerman et al., 1991)
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Timepoint [7]
436795
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [8]
436796
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salience and coherence, response efficacy, cancer worries, social influence on/about cancer screening
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Assessment method [8]
436796
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Preventative Health Model measure adapted from Vernon et al., 1997
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Timepoint [8]
436796
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [9]
436797
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Self-efficacy to complete colorectal cancer screening tests
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Assessment method [9]
436797
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Measure based on the Preventative Health Model (Vernon et al., 1991)
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Timepoint [9]
436797
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [10]
436798
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Self-efficacy to complete melanoma cancer screening tests
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Assessment method [10]
436798
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Barriers and facilitators to a clinical full body skin check (melanoma) based on Kasparian et al. (2012)
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Timepoint [10]
436798
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [11]
436799
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(Biologically female participants only) Self-efficacy to complete breast cancer screening tests
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Assessment method [11]
436799
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Self-efficacy scale for mammography (Champion et al., 2005)
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Timepoint [11]
436799
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [12]
436800
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(Biologically male participants only) Self-efficacy to complete prostate cancer screening tests
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Assessment method [12]
436800
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Informed Prostate Cancer Screening Decision Self-Efficacy Scale (Owens et al., 2020)
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Timepoint [12]
436800
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [13]
436801
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Intentions to perform colorectal cancer screening tests
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Assessment method [13]
436801
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Measure based on the Theory of Planned Behaviour adapted from Vernon et al (1997)
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Timepoint [13]
436801
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [14]
436802
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Intentions to perform melanoma screening tests
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Assessment method [14]
436802
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Measure based on the Theory of Planned Behaviour adapted from Vernon et al (1997)
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Timepoint [14]
436802
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [15]
436803
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(Biologically female participants only) Intentions to perform breast cancer screening tests
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Assessment method [15]
436803
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Measure based on the Theory of Planned Behaviour adapted from Vernon et al (1997)
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Timepoint [15]
436803
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [16]
436804
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(Biologically male participants only) Intentions to perform prostate cancer screening tests in the next three months
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Assessment method [16]
436804
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Measure based on the Theory of Planned Behaviour adapted from Vernon et al (1997)
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Timepoint [16]
436804
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Baseline, 1, 6 and 12 months post-delivery of the intervention or attention control
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Secondary outcome [17]
436990
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Clinical outcomes of screening tests for colorectal, melanoma, breast and prostate cancer
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Assessment method [17]
436990
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Rate of abnormal screening test for colorectal, melanoma, breast and prostate cancer. Data will be collected from participant self report, general practice medical records and administrative datasets; Medicare billing of cancer screening, National Bowel Cancer Screening Program, BreastScreen Victoria and the Victorian Admitted Episodes Dataset.
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Timepoint [17]
436990
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12 months post-delivery of the intervention or attention control
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Secondary outcome [18]
436991
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Clinical outcomes of screening tests for colorectal, melanoma, breast and prostate cancer
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Assessment method [18]
436991
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Rate of diagnosis for colorectal, melanoma, breast and prostate cancer.Data will be collected from participant self report, general practice medical records and administrative datasets; Medicare billing of cancer screening, National Bowel Cancer Screening Program, BreastScreen Victoria and the Victorian Admitted Episodes Dataset.
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Timepoint [18]
436991
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12 months post-delivery of the intervention or attention control
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Secondary outcome [19]
436992
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The rate of risk-appropriate screening behaviours for colorectal, melanoma, breast and prostate cancer. The numerator is the total count of risk-appropriate screening behaviours which were due and completed within 5 years post-delivery of the intervention or attention control and the denominator is the number of participants in each group.
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Assessment method [19]
436992
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Risk-appropriate screening will be defined by the method of risk assessment in each trial group (i.e. based on usual care (age and family history) in controls and polygenic risk scores (incorporating genomic data, age, sex and family history) in the intervention group. Data will be collected from administrative datasets for each participant; Medicare billing of cancer screening, National Bowel Cancer Screening Program, BreastScreen Victoria and the Victorian Admitted Episodes Dataset.
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Timepoint [19]
436992
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5 years post-delivery of the intervention or attention control
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Eligibility
Key inclusion criteria
•Are aged between 40 and 59 years
•Are able to read and write English and competent to give informed consent
•Are contactable over the next 12 months for trial follow-up
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Minimum age
40
Years
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Maximum age
59
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
•Have been diagnosed with any of breast, prostate, colorectal cancer or melanoma;
•Have any alarm symptoms that are potentially indicative of any cancer:
Once or more and not investigated:
Blood in stool or urine
•For more than four weeks and not investigated:
Problems with urination
Diarrhoea
Unexplained weight loss
An unusual pain, lump or swelling anywhere in the body
A new or changed spot on the skin;
•Have a known genetic predisposition to any of the four cancers in question or, a first-/second-degree relative with a genetic predisposition and the participants has not had genetic testing themselves. This includes (but is not limited to) by a pathogenic variant in any of the following genes:
CRC: Lynch syndrome (MLH1, PMS2, MSH2, MSH6, EPCAM), familial adenomatous polyposis (APC);
BrCa: BRCA1, BRCA2, PALB2, ATM, CHEK2;
PrCa: BRCA1, BRCA2, HOXB13;
Melanoma: CDKN2A/p16.
•Have any health condition or illness that, in the opinion of the participant or researcher, would impact their appropriateness for cancer screening or their ability to participate
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Study design
Purpose of the study
Diagnosis
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation occurs following the recruitment and baseline data collection of a participant. Researchers involved in this process are blinded to the sequence of allocation as this is uploaded to the trial database randomisation module by a biostatistician removed from any participant-facing trial activities.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Baseline data will be entered into an online trial database prior to randomisation; participants will be randomly allocated 1:1 to intervention or control. The allocation sequence will be computer generated to ensure allocation concealment, sequentially within each stratum (general practice) using a biased-coin algorithm that will be embedded within the online database.
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
2/09/2024
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Actual
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Date of last participant enrolment
Anticipated
2/09/2025
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Actual
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Date of last data collection
Anticipated
31/12/2030
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Actual
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Sample size
Target
392
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Funding & Sponsors
Funding source category [1]
315113
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Government body
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Name [1]
315113
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The Medical Research Future Fund (MRFF), Department of Health and Aged Care
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Address [1]
315113
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The Medical Research Future Fund (MRFF) Department of Health GPO Box 9848 Canberra ACT 2601
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Country [1]
315113
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Australia
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Primary sponsor type
University
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Name
University of Melbourne
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Address
Parkville Melbourne VIC 3010
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Country
Australia
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Secondary sponsor category [1]
317130
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None
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Name [1]
317130
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Address [1]
317130
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Country [1]
317130
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
314051
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University of Melbourne Central Human Research Ethics Committee
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Ethics committee address [1]
314051
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https://research.unimelb.edu.au/work-with-us/ethics-and-integrity/our-ethics-committees
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Ethics committee country [1]
314051
0
Australia
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Date submitted for ethics approval [1]
314051
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14/05/2024
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Approval date [1]
314051
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Ethics approval number [1]
314051
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Summary
Brief summary
This study aims to evaluate the effect on risk-appropriate cancer screening of multi-cancer polygenic risk scores and tailored advice on risk-appropriate cancer screening in general practice. Who is it for? People aged 40-59 years old who are able to read and write in English and currently do not have any alarm symptoms or diagnosis of cancer. All participants must be under the care of a General Practitioner who is participating in the trial. Study Details Participants will be randomly allocated into the intervention or control group. The intervention group will receive an individualised cancer risk report and tailored advice for risk-appropriate screening for melanoma, colorectal, and breast or prostate cancer during a consultation with a researcher . The control group will receive the ‘Cut your Cancer Risk’ brochure and information about lifestyle factors that can impact cancer risk during a consultation with a researcher. This study will contribute to what we know about how individualised risk information can impact peoples' cancer screening behaviours.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
130242
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Prof Jon Emery
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Address
130242
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University of Melbourne Centre for Cancer Research, Level 10, Victorian Comprehensive Cancer Centre 305 Grattan St Melbourne Victoria 3000
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Country
130242
0
Australia
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Phone
130242
0
+61 03 85597189
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Fax
130242
0
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Email
130242
0
[email protected]
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Contact person for public queries
Name
130243
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Dr Sibel Saya
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Address
130243
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University of Melbourne Centre for Cancer Research, Level 10, Victorian Comprehensive Cancer Centre 305 Grattan St Melbourne Victoria 3000
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Country
130243
0
Australia
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Phone
130243
0
+61 03 85597189
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Fax
130243
0
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Email
130243
0
[email protected]
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Contact person for scientific queries
Name
130244
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Dr Sibel Saya
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Address
130244
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University of Melbourne Centre for Cancer Research, Level 10, Victorian Comprehensive Cancer Centre 305 Grattan St Melbourne Victoria 3000
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Country
130244
0
Australia
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Phone
130244
0
+61 03 85597189
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Fax
130244
0
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Email
130244
0
[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF