Breast Cancer Risk Counseling Research Articles

Pilot study of a culturally sensitive intervention to promote genetic counseling for breast cancer risk

BackgroundDespite the benefits of genetic counseling and testing, uptake of cancer genetic services is generally low and Black/African American (Black) women are substantially less likely to receive genetic services than non-Hispanic White women. Our team developed a culturally sensitive, narrative decision aid video to promote uptake of genetic counseling among Black women at risk for a hereditary breast cancer syndrome that can be incorporated in conjunction with population-based cancer risk assessment in a clinical setting. We report here a pilot study to demonstrate changes in intention to access genetic counseling and intervention satisfaction.MethodsBlack women who were personally unaffected by breast cancer and were recommended for genetic counseling based on family history screening in a mammography center were recruited at the time of the mammogram. A prospective, pre-post survey study design, guided by theoretical constructs, was used to evaluate baseline and immediate post-intervention psychosocial factors, including intention to participate in genetic counseling and intervention satisfaction.ResultsPilot recruitment goals were met (n = 30). Pre-intervention, 50% of participants indicated that they were extremely likely to make a genetic counseling appointment, compared with 70% post-intervention (p = 0.05). After watching the intervention, 50% of participants indicated that the video changed their mind regarding genetic counseling.ConclusionsThis study demonstrated cultural satisfaction with a decision aid intervention designed to motivate Black women with hereditary breast cancer risk to attend a genetic counseling appointment. Our study showed that intention may be a specific and key construct to target in interventions designed to support decision-making about genetic services. Study results informed the design of a subsequent large scale, randomized implementation study.Trial registrationTrial registration: Clinicaltrials.govNCT04082117.Registered September 9, 2019.Retrospectively registered.

Abstract B057: Promoting genetic counseling among African American women with hereditary risk for breast cancer

Abstract Background: Breast cancer mortality is substantially higher in the U.S. for African American (AA) women compared to their white counterparts. Increasing the uptake of genetic counseling among AA women identified with increased breast cancer risk in Federally Qualified Health Centers (FQHC) is a key step in developing a successful approach to breast cancer disparities. However, studies show that women of color are less likely to receive genetic counseling for breast cancer risk. Our research group developed a multimedia culturally tailored educational video, informed by multiple qualitative methods, to improve uptake of genetic counseling among underserved AA women with increased breast cancer risk. We are conducting a pilot study to demonstrate the feasibility of incorporating the intervention with cancer genetic risk assessment in a mammography clinic. Methods: AA women will be recruited at the University of Illinois Mammography Center. Per current standard of care, all women who present for a mammogram complete a cancer genetic risk assessment (CGRA) as part of clinic intake. Women recommended for genetic counseling by the assessment tool will be invited to participate in this study. Participation includes: a pre-survey, viewing the educational video, and a post-survey. Pre- and post survey questions will capture data on the following constructs: knowledge, attitudes, normative beliefs, motivation, perceived social norms, intention to engage in genetic counseling, efficacy beliefs, skills, environmental constraints and opinions on video. Genetic counseling attendance will be monitored via electronic medical record. Thirty participants will be enrolled. Results: Preliminary results will be presented at the meeting. Conclusion: Culturally tailored health communication tools have shown to increase positive health behaviors. It is expected that the culturally tailored educational intervention will increase knowledge, motivation and intention to attend genetic counseling. Citation Format: Vida Henderson, Delawnia Comer-Hagans, Vickii Coffey, Giesela Grumbach, Jennifer Newsome, Kent Hoskins. Promoting genetic counseling among African American women with hereditary risk for breast cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B057.

Exploring Explanatory Models of Risk in Breast Cancer Risk Counseling Discussions: NSABP/NRG Oncology Decision-Making Project 1.

Explanatory models represent patient understanding of etiology, pathophysiology, illness, symptoms, and treatments, but little attention has been paid to how they are used by patients "at risk" for future disease. The aims of this study were to elucidate what constitutes an explanatory model of risk and to describe explanatory models of risk related to developing breast cancer. Thirty qualitative interviews with women identified as at an increased risk for breast cancer were conducted. Interviews were coded to identify domains of explanatory models of risk using a priori codes derived from the explanatory model of illness framework. Within each domain, a grounded thematic analysis described participants' explanatory models related to breast cancer risk. The domains of treatment and etiology remained similar in a risk context compared with illness, whereas course of illness, symptoms, and pathophysiology differed. We identified a new, integrative concept relative to other domains within explanatory models of risk: social comparisons, which was dominant in risk perhaps due to the lack of physical experiences associated with being "at risk." Developing inclusive understandings of risk and its treatment is key to developing a framework for the care of high-risk patients that is both evidence based and sensitive to patient preferences. The concept of "social comparisons" can assist healthcare providers in understanding women's decision making under conditions of risk. Ensuring that healthcare providers understand patient perceptions of risk is important because it relates to patient decision making, particularly due to an increasing focus on risk assessment in cancer.

Deciding on breast cancer risk reduction: The role of counseling in individual decision-making – A qualitative study

ObjectivesThe presentation of risks and benefits in clinical practice is common particularly in situations in which treatment recommendations involve trade-offs. The treatment of breast cancer risk with selective estrogen receptor modulators (SERMs) is such a decision. We investigated the influence of health care provider (HCP) counseling on women’s decision-making. MethodsThirty breast cancer risk counseling sessions were recorded from April 2012–August 2013 at a comprehensive cancer center and at a safety-net, community hospital in the US. Participating women and HCPs were interviewed. A cross-case synthesis was used for analysis. ResultsOf 30 participants 21 received a SERM-recommendation, 11 decided to take SERMs. Counseling impacted decision-making, but did not determine it. Three categories emerged: 1.) ability to change the decision anytime, 2.) perceptions on medications, and 3.) proximity of cancer. ConclusionDecision-making under conditions of a risk diagnosis such as increased breast cancer risk is a continuous process in which risk information is transformed into practical and experiential considerations. Practice implicationsIndividuals’ health care decision-making is only marginally dependent on the interactions in the clinic. Accepting patients’ experiences and beliefs in their own right and letting them guide the discussion may be important for a satisfying decision-making process.

Abstract P1-11-02: Identifying women at high-risk for breast cancer in the primary care setting

Abstract Background: Breast cancer risk assessment and available interventions for prevention, such as chemoprevention, are underutilized in the U.S. Reasons for low uptake include inability to routinely identify high-risk women in the primary care setting, inadequate time for counseling, and insufficient knowledge about risk-reducing strategies among primary care providers (PCPs) and patients. Our goal is to expand breast cancer risk counseling to a broader population of high-risk women identified in the primary care setting by developing a novel breast cancer risk navigation (BNAV) tool integrated into the electronic health record (EHR). Methods: We propose to design the BNAV tool for PCPs, by integrating the Gail breast cancer risk assessment tool into the EHR. Our goal is to facilitate clinic workflow for the identification of high-risk women (5-year risk ≥1.7% or lifetime risk ≥20%), who may be referred for specialized risk counseling. We conducted recorded focus groups and individual interviews of PCPs (N = 20-25) at Columbia University Medical Center (CUMC), including internists, family practitioners, and gynecologists who use an EHR and see female patients, age 40-70 years, in the outpatient setting. We performed user analyses of PCPs on the characteristics of their practice and their clinic workflow. Information about the aims of BNAV and the development process were provided and PCPs were given an opportunity to ask questions and discuss the relative merits of BNAV and its potential application to clinical practice. Providers also completed a questionnaire to provide quantitative and qualitative feedback on BNAV. Verbal and written qualitative responses were condensed into themes using a qualitative approach based on grounded theory. Results: In terms of breast cancer risk assessment, few providers routinely assessed for breast cancer risk factors apart from family history. Although some were familiar with the Gail model, no one used the risk calculator in their practice. Many PCPs were concerned about the added burden of incorporating the Gail model into the clinic visit. Potential solutions included screening for high-risk women during mammography and having patients complete the Gail model while in the waiting rooms. Most PCPs preferred referring high-risk women for specialized risk counseling, rather than directly discussing chemoprevention with their patients. Results from our interviews informed the selection of electronic resources to configure the BNAV tool. Using an open application programming interface within the EHR, the BNAV tool will incorporate the following approaches to workflow integration: 1) external decision support plug-ins for risk calculation; 2) dashboards with informatics-enabled summaries of patient history and breast cancer risk factors; 3) extracting data already available in the EHR for the Gail model breast cancer risk calculation; 4) alerts indicating high-risk patients should be referred for specialized risk counseling; 5) semi-structured referral orders for high-risk consultations. Discussion: PCPs are on the front lines of preventive medicine and initiating the appropriate high-risk referrals. We propose to use health information technology methods to overcome barriers to breast cancer chemoprevention in the primary care setting. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-11-02.

Genetic counseling for breast cancer risk: how did we get here and where are we going?

Genetic counselors have been helping patients navigate hereditary cancer risk for decades. The rapidly changing landscape of genetic testing options means the field is again at a unique time in its history. Fears that arose when BRCA testing first became available are again being voiced in light of next-generation sequencing. The origins of genetic counseling, best practices, and recommendations that have come about since those early days need to be well understood before these new challenges can be met. The role of a proper risk assessment in preventing adverse outcomes is vital as options for testing change. In addition, an understanding of how various countries have incorporated genetic testing and genetic counseling into their healthcare systems can provide lessons in moving forward and capitalizing on the new technology that is again creating a genetics revolution.

Abstract A41: Does medical mistrust influence black women's participating in BRCA1/2 genetic counseling and testing?

Abstract Approximately 5%-10% of breast cancers are heritable. Clinical evidence supports the value of BRCA1/2 genetic counseling and testing (GC/T) for hereditary breast and ovarian cancer risk. However, BRCA1/2 GC/T is underutilized among Black women and reasons are not well understood. We examined the potential influence of medical mistrust on GC/T participation in a sample of 100 Black women at increased risk for carrying a BRCA1/2 mutation. Eligible participants fell into one of three groups: 1) healthy women with > 1 first-degree relative (FDR) affected by breast and/or ovarian cancer, 2) women diagnosed with breast cancer at < 50 years of age, and 3) women diagnosed with breast and/or ovarian cancer at > 50 years of age with either one FDR or two second degree relatives with breast and/or ovarian cancer. Participants were recruited from hospital and community settings and completed a researcher-administered survey. The dependent variable indicated women's GC/T participation (0 = unaware, 1=aware but had no referral, and; 2 = received a referral and/or GC/T). Medical Mistrust was assessed using the 7-item Medical Mistrust Index (Cronbach's α ≥ 0.70) Bivariate tests and multivariate regression analyses were employed. GC/T participation was only 28%. After accounting for sociodemographic factors and self-efficacy (B = 0.37, p < .001), multivariate analysis revealed that women with higher medical mistrust had lower GC/T participation (B = −0.26, p <.01). Interventions to improve utilization of GC/T in Black women at increased risk should incorporate strategies to enhance their personal confidence and address women's concerns about the medical system. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A41.

Interest and Beliefs About BRCA Genetic Counseling Among At‐Risk Latinas in New York City

Latinas are less likely to use genetic services (counseling and testing) for hereditary breast and/or ovarian cancer risk compared to other ethnic groups. Meanwhile, little is known about barriers to genetic counseling among Latinas at increased risk of inherited breast cancer. A two-phase pilot study was conducted to examine interest, barriers and beliefs about BRCA genetic counseling among at-risk Latinas in New York City and explore the potential for developing a culturally-tailored narrative educational tool for use in future studies. Phase 1 included quantitative telephone interviews (N = 15) with bilingual participants with a personal diagnosis at a young age and/or family history of breast and/or ovarian cancer. Quantitative results informed development of a narrative prototype educational presentation viewed by a subset of participants (N = 10) in Phase 2 focus groups. Despite barriers, including lack of awareness/knowledge, concerns related to learning cancer risks of family members, and concerns about cost/health insurance, participants reported positive attitudes, beliefs and interest in learning about BRCA genetic counseling. Further, significant increases in knowledge were demonstrated from pre-post presentation (p = 0.04). There is an unmet need to educate at-risk Latinas about BRCA genetic counseling. Culturally-tailored educational materials including narratives may increase knowledge about BRCA genetic counseling among this underserved group. The effectiveness of these approaches should be tested in future research with larger samples.

Breast Cancer Events Associated with Germline Mutations of the CDH1 Gene (Hereditary Diffuse Gastric Cancer).

Abstract Breast cancer events associated with germline mutations of the CDH1 gene (Hereditary Diffuse Gastric Cancer).Background: Mutations of the CDH1 (e-cadherin) gene are known to cause an autosomal dominant familial cancer syndrome, commonly referred to as hereditary diffuse gastric cancer. The lifetime risk of gastric cancer may be up to 80 percent. An associated risk of lobular breast cancer has been identified, but less well studied. Lifetime risk of breast cancer in affected women may be up to 50 percent.Method: We identified 17 women in our centre with known CDH1 mutations that have been offered genetic counseling for breast cancer risk. Counseling included discussion of prophylactic surgery, and breast screening via MRI/mammogram. We performed a chart review to identify breast cancer screening, prophylaxis, and treatment events in these patients.Results: 16 patients had adequate chart data to study. Of these, one patient had a breast cancer (T3N0M0) prior to mutation identification. 13 of 15 remaining patients entered into a high-risk breast-screening program with annual MRI and mammogram. Two breast cancers were identified in the first two years of patient screening; both were T1N0M0. Both women opted for bilateral mastectomy. No patient opted for prophylactic breast surgery prior to cancer detection, although several were in the process of prophylactic gastrectomy.Conclusion: To our knowledge, this is the first in-depth description of breast cancer events in patients with inherited CDH1 mutations. A majority of patients have opted for a breast-screening program, with successful early detection in two patients. Patients to date have not chosen primary prophylactic breast surgery, but two have chosen bilateral mastectomy upon detection of a malignancy. Further epidemiological studies are required to fully understand the breast cancer pattern and natural history that occurs in this genetic syndrome. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 904.

Sexual Orientation and Intentions to Obtain Breast Cancer Screening

This longitudinal study examined predictors of intentions to obtain breast cancer screening in two samples, one comprising self-identified lesbian/bisexual women (n = 150) and the other comprising heterosexual women (n = 400). We hypothesized that beliefs about mammography, cancer vulnerability, and attitudes toward the medical provider would mediate the relationship between sexual orientation and plans to obtain breast cancer screening. Women in this study participated in one of two larger clinical trials of breast cancer risk counseling methods. All participants completed questionnaires about breast cancer screening attitudes at baseline and at a 6-month follow-up. Logistic regression analyses, controlling for age, education, and race, revealed that baseline negative beliefs about mammography, lower levels of provider trust, and less perceived risk of breast cancer significantly mediated the relationship between sexual orientation and 6-month intentions to obtain a clinical breast examination (CBE) and mammography. These findings suggest that attitudes and beliefs about breast cancer, breast cancer screening, and medical providers impact lesbian/bisexual women's willingness to plan for CBE and mammography.

The influence of acculturation and breast cancer‐specific distress on perceived barriers to genetic testing for breast cancer among women of African descent

Rising health disparities are increasingly evident in relation to use of genetic services (including genetic counseling and testing) for breast cancer risk, with women of African descent less likely to use genetic services compared with Whites. Meanwhile, little is known regarding potential within-group acculturation and psychological differences underlying perceived barriers to genetic testing among women of African descent. Hypothesized contributions of acculturation factors and breast cancer-specific distress to perceived barriers to genetic testing were examined with a statistical analysis of baseline data from 146 women of African descent (56% US born and 44% foreign born) meeting genetic breast cancer risk criteria and participating in a larger longitudinal study that included the opportunity for free genetic counseling and testing. Perceived barriers assessed included: (1) anticipation of negative emotional reactions, (2) stigma, (3) confidentiality concerns, (4) family-related worry, and (5) family-related guilt associated with genetic testing. In multivariate analyses, being foreign born was a significant predictor of anticipated negative emotional reactions about genetic testing (beta=0.26; SE=0.11; p=0.01). Breast cancer-specific distress scores (avoidance symptoms) were positively related to anticipated negative emotional reactions (beta=0.02; SE=0.005; p=<0.0001), confidentiality concerns (beta=0.02; SE=0.01; p=0.02), and family-related guilt (beta=0.02; SE=0.01; p=0.0009) associated with genetic testing. Results suggest an influence of acculturation and breast cancer-specific distress on perceived barriers to genetic testing among women of African descent. The potential utility of culturally tailored genetic counseling services taking into account such influences and addressing emotional and psychological concerns of women considering genetic testing for breast cancer should be investigated.

Breast Cancer Risk Reduction and Counseling: Lifestyle, Chemoprevention, and Surgery

Qualitative and quantitative approaches to risk assessment are useful for identifying women at increased risk for developing breast cancer for whom genetics consultation, individualized surveillance recommendations, or chemoprevention may be appropriate. A comprehensive medical and family history review can be used to stratify women into categories of breast cancer risk. A quantitative estimate of the probability of developing breast cancer can be determined using risk assessment tools, such as the Gail and Claus models. Women at increased risk for breast cancer may benefit from individualized approaches to breast cancer risk reduction. Prevention strategies for reducing breast cancer risk include lifestyle modifications, chemoprevention, surgical approaches, and pharmacotherapy.

Genetic Counseling for Breast Cancer Risk: General Concepts, Challenging Themes and Future Directions

This article reviews the elements and process of genetic counseling for breast cancer risk, including contracting, informed consent, and psychosocial assessment and counseling. Case studies and pedigrees are utilized to illustrate current approaches to issues and challenges in the field. For example, the following topics are explored: test result interpretation, including uninformative BRCA1/2 test results; testing strategies and test selection; family concerns; patient follow-up and recontact; risk counseling in double heterozygotes; and reproductive options for mutation carriers. Concerns in specific populations such as newly diagnosed breast cancer patients, young unaffected high-risk women, and males are also reviewed. Alternative forms of and adjuncts to traditional face-to-face genetic counseling are discussed.

International Perspectives on Genetic Counseling and Testing for Breast Cancer Risk

Familial cancer services have been developed in many countries in response to a rapidly evolving demand for genetic counseling and testing for breast cancer risk. This article presents a synthesis of the literature on international aspects of genetic counseling and testing and discusses similarities and differences in the provision of genetic counseling and testing, taking seven countries with well established familial cancer services as a case study (Australia, Canada, France, Germany, Netherlands, UK and US). Potential international differences are discussed in terms of: provider and patient attitudes to genetic counseling and genetic testing; utilization rates of genetic testing and prophylactic surgery; and the psychological impact of genetic testing for breast cancer risk. The comparative analyses of utilization rates and the psychological impact of testing indicate a wide range of variability in uptake rates and psychological outcomes, most likely reflecting sample variability and methodological differences in measurement. International comparison studies using controlled designs would be required to ascertain whether international differences exist, and to disentangle the differential role of clinical, individual and family context factors, on the one hand, and the cultural and health system-related factors unique to particular countries, on the other.

"Why Take It If You Don't Have Anything?" Breast Cancer Risk Perceptions and Prevention Choices at a Public Hospital

Journal of General Internal MedicineVolume 21, Issue 7 p. A‐7-A‐7 Free Access “Why Take It If You Don't Have Anything?” Breast Cancer Risk Perceptions and Prevention Choices at a Public Hospital First published: 01 June 2006 https://doi.org/10.1111/j.1525-1497.2006.00461_1.x Address correspondence and requests for reprints to Dr. Lauderdale: Department of Health Studies, University of Chicago, 5841 Maryland Ave., MC 2007, Chicago, IL 60637 (e-mail: lauderdale@health.bsd.uchicago.edu). AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract We conducted semi-structured interviews with 33 women attending breast cancer risk counseling at a public hospital high risk clinic to elicit their understandings of their risk and their attitudes towards prevention. Women's views of risk differed from the medical model: many felt they were not “high risk” because they lacked signs and symptoms of cancer and some feared that “dwelling on” one's risk might lead to cancer. While screening was welcomed, taking tamoxifen to prevent cancer was generally seen as harmful and useful only as treatment. Physicians and researchers should recognize and address alternative ways that diverse patients understand risk. Volume21, Issue7July 2006Pages A‐7-A‐7 RelatedInformation

Results of a randomized study of telephone versus in-person breast cancer risk counseling

Objective Women of all risk levels have reported high interest in obtaining genetic testing for breast cancer risk. Breast cancer risk counseling may help women to learn about their risk and appropriate options of testing. This study measured the effects of an intervention in-person and by telephone, compared to a control group. Methods Participants were 340 women, recruited through a network of primary care physicians. They received a baseline questionnaire in the mail, were randomized to one of the three study arms, and completed a follow-up survey 3 months later. Results Both types of counseling were very well received. The counseling decreased women's cancer worry, risk perceptions, and intentions to pursue genetic testing. There were similar effects for both in-person and telephone counseling. Conclusion Genetic counseling can be used to inform women at all risk levels about their breast cancer risk. Practice implications Breast cancer risk counseling can be done in-person and by telephone – thereby reaching women in remote areas.

Effects of Breast Cancer Risk Counseling for Sexual Minority Women

Sexual minority women (lesbian and bisexual) represent a vulnerable group regarding their breast health. The participants in this study were 150 women aged 18–74 recruited via public announcements in mainstream and sexual minority communities in the greater Seattle metropolitan area. Potential participants were recruited to participate in a randomized trial of a breast cancer risk counseling intervention for sexual minority women. The counseling intervention produced significant reductions in perceived risk of breast cancer, anxieties and fears about breast cancer at 6 and 24 months, and increases in breast screening rates at 24 months in the intervention arm, compared with the control arm participants. These data add to the growing body of knowledge on sexual minority women's health and point to areas of community action and future research.

Facilitating Informed Decision Making about Breast Cancer Risk and Genetic Counseling Among Women Calling the NCI's Cancer Information Service

ABSTRACT Despite increased interest among the public in breast cancer genetic risk and genetic testing, there are limited services to help women make informed decisions about genetic testing. This study, conducted with female callers (N = 279) to the National Cancer Institute's (NCI's) Atlantic Region Cancer Information Service (CIS), developed and evaluated a theory-based, educational intervention designed to increase callers' understanding of the following: (a) the kinds of information required to determine inherited risk; (b) their own personal family history of cancer; and (c) the benefits and limitations of genetic testing. Callers requesting information about breast/ovarian cancer risk, risk assessment services, and genetic testing were randomized to either: (1) standard care or (2) an educational intervention.Results show that the educational intervention reduced intention to obtain genetic testing among women at average risk and increased intention among high-risk women at 6 months. In addition, high monitors, who typically attend to and seek information, demonstrated greater increases in knowledge and perceived risk over the 6-month interval than low monitors, who typically are distracted from information. These findings suggest that theoretically designed interventions can be effective in helping women understand their cancer risk and appropriate risk assessment options and can be implemented successfully within a service program like the CIS.

Breast cancer risk counseling improves women’s functioning

Helping people cope with health risks is an important area for research and practice. Counseling offers people the opportunity to relieve their distress and improve the ways in which they manage their health issues. This study was a randomized test of two different counseling methods, genetic and psychosocial counseling, compared to a control group. Eligibility requirements included being between 18 and 74 years old, having at least one relative with breast cancer, not having a family history consistent with carrying a BRCA1/2 mutation for breast cancer risk, having no personal history of breast or ovarian cancer, living within 60 miles of the research institute, and willingness to complete the research requirements of the project. Perceived risk decreased by 50% for participants in the two counseling groups relative to comparison participants. Cancer worry decreased in both counseling groups by one scale point ( P<0.05). These results indicate that counseling can relieve women’s negative reactions to breast cancer risk.

Measures and Correlates of Resilience

ABSTRACT Objective: We collected data on several aspects of resilience and related them to personal perceptions of breast cancer risk and worry about cancer. Methods: As part of an ongoing series of studies to examine women's needs for and responses to breast cancer risk counseling, women with a family history of breast cancer (n = 357) completed questionnaires as part of their ongoing follow-up for counseling interventions. The questionnaire contained several measures of resilience: Optimism, the Life Attitude Profile-Revised, and single item scales measuring the worst to best possible life for past, present and future time periods. We also measured quality of life, social desirability, cancer worry, and personal perceived risk of breast cancer. We analyzed the relationships among resilience variables to determine the best measures of resilience from among the measures used. We then related resilience measures to breast cancer worry and risk. Results: Overall, the relationships among the resilience variables varied considerably. The average worst to best possible life ratings increased from past to present to future, and only current and future estimates were highly correlated (r = .62; p < 0.01). Optimism was not correlated with any other resilience variable, suggesting that it is measuring some other construct. None of the resilience measures were highly correlated with social desirability, indicating that resilience is not simply a measure of self-promotion. Quality of life measures correlated most highly with present life ratings (r = .54; p < 0.01). Perceived cancer worry and risk were negatively correlated with future and present life ratings, but at very low levels (r's = − .20 and − .21; p < 0.001 for both). Analyses predicting risk and worry using a subset of resilience variables are presented. Conclusion: These data will help to identify resilient women and how they view and manage their health risks.