CORE D: SUMMARY/ABSTRACT The ability to effect change in healthcare is as dependent on a successful implementation as it is on the intervention itself. Personalization of screening and targeted risk reduction proposed by this Program Project is an ambitious undertaking that must be highly integrated with patient centered outcomes as proposed in this Core. In addition to clinical outcomes, the impact of the proposed interventions on patient-centered outcomes is affected by perceptions, behaviors, psychosocial outcomes, and personal costs. Therefore, optimizing adherence requires addressing perceptions and willingness to accept and try new approaches; this will be critical to the overall success of the project, as will the assessment of patient-centered outcomes. Perhaps the biggest challenge of a personalized screening approach is not whether it works, but whether, if it is shown to be better, it will be accepted and embraced, since it is a big departure from our practice today. The overarching objectives of the Patient Center Outcomes and Cost-Effectiveness (PCO-CE) Core are to establish innovative approaches that improve education and adherence to breast cancer screening and risk reduction recommendations and guidelines, and to collect patient-centered outcomes data to support the cost- effectiveness analysis and the proposed Project Program Framework. The Patient Centered Outcomes and Cost-effectiveness (PCO-CE) will ensure enhanced translation, education, communication, and outcomes measurement with a focus on adherence and non-adherence to risk-based recommendations. The Core will aim to improve translation of personal data into breast cancer screening and risk reduction behaviors that match recommendations by creating and delivering educational innovative multi-media material for each risk-stratified screening recommendation in both English and Spanish, and testing if the materials improve participant: (a) understanding of breast cancer risk; (b) understanding of their screening recommendation, and (c) adherence to their risk recommendation. We will complement this effort by developing communication strategies and infrastructural interventions for radiologists, primary care physicians and other clinician groups to improve adherence to risk-based screening recommendations. Finally, the PCO-CE core will be responsible for integration of patient-centered outcomes measures within the framework of the cost-effectiveness analysis that will help make the case for broader generalization, dissemination, and adoption.