Perceived Breast Cancer Risk Research Articles

Complementary and alternative medicine (CAM) use in high-risk women in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab)

1528 Background: Complementary and alternative medicines (CAMs) are frequently utilized by cancer patients, but there are few data regarding use in well individuals with high cancer risk. Methods: Data on CAM use in females with a strong family history of breast cancer (BC) but no personal cancer history was obtained using a questionnaire mailed 6 years after their enrolment in the kConFab BC family cohort study. CAM use was analysed for demographic and psychosocial predictors of use using multivariate logistic regression. Results: Of the 1,373 women, 1,001 (73%) responded; 109 were excluded as they were not at high cancer risk (spouses or mutation negative), leaving 892 high-risk women. 55% (n=489) used CAM, but only 6% (n=53) used CAM specifically to prevent cancer. The three most common CAMs were vitamins/supplements (n=266, 54%), low fat diet (n=151, 31%) and massage (n=138, 28%). The CAM most frequently used specifically to prevent cancer was green tea (n=19, 26% of all CAM use to prevent cancer), followed by soy rich diet (n=12, 16%) and vitamins/supplements (n=12, 16%). CAM use was independently associated with higher education level (OR 2.56, 95%CI 1.84- 3.56, p<0.001), greater physical activity (OR 1.05 per hour of physical activity/week, 95%CI 1.002–1.10, p=0.04) and lower perceived BC risk (OR 0.99 per percentage of perceived risk, 95%CI 0.98–0.99, p<0.001). Conclusions: Only a small number of women at high risk for BC used CAM specifically to prevent cancer. This suggests that women do not consider CAM as a cancer risk management strategy. The associations between CAM use and higher education and greater physical activity are consistent with the limited literature, but that with lower perceived cancer risk is novel. Clinicians should routinely take a CAM history, given a potential for interactions with chemoprevention medications. No significant financial relationships to disclose.

Collective memory, candidacy, and victimisation: community epidemiologies of breast cancer risk

Collectively shared ideas of community may be equally relevant for the study of health disparities as quantifying the relationship between community structures and health. Data from focus groups (N = 18) that explored understandings of breast cancer and breast cancer risk in African American neighbourhoods revealed three conceptual domains where shared ideas of community informed responses: collective memory, community candidacy, and community victimisation by external aggressors. Reading the focus group responses in terms of these domains identified perceptions of risk and of candidacy that may be overlooked by individualised or quantitative approaches to studying breast cancer risk perceptions and related behaviours. These include novel perceived risks, such as the 'risk of knowing', as well as community-level constructions of breast cancer candidacy. 'Lay epidemiologies' of breast cancer within this population might therefore be better understood as 'community epidemiologies', where community is central to the interpretation and operationalisation of breast cancer risk. Paying attention to such community epidemiologies of breast cancer provides theoretical insights for studying breast cancer disparities and risk perceptions as well as useful guidance for designing interventions.

Predictors of Cancer Worry in Unaffected Women from High Risk Breast Cancer Families: Risk Perception is not the Primary Issue

Some women at increased familial risk of breast cancer experience elevated levels of cancer-specific worry, which can possibly act as a barrier to screening, and may be a significant factor in decisions regarding risk-reducing surgery. The aim of this study was to comprehensively examine predictors of cancer-specific worry in high risk women and to test a model which proposes that perceived breast cancer risk mediates the impact of other factors on worry. 1,437 unaffected women from high risk breast cancer families completed questionnaires and interviews. Path analysis was used to test the model of potential predictors of cancer worry, including familial, personal and psychological variables, mediated via perceived cancer risk. Levels of cancer-specific worry were generally low despite an average perceived risk of 50.3%. The goodness-of-fit of the proposed model was poor, explaining only 9% of the variance for perceived risk and 10% of the variance for cancer specific worry. An alternative model of a direct relationship between all of the predictor variables and cancer worry, explained 24% of the variation in cancer worry. General anxiety, perceived risk, the stressful impact of recent cancer related events, a relative risk greater than 10, being closer in age to the youngest breast cancer diagnosis in family, and knowledge of personal mutation status, all independently contributed to cancer worry. Addressing general affective responses, experiences of recent cancer related events, in addition to education about personal risk, should be considered in counselling women with elevated cancer worry. Risk perception appears to act independently of other factors in its formulation and impact on cancer worry. Further research on the way in which women come to perceive their risk is indicated.

Interest in breast cancer chemoprevention among older women

The study aim is to describe interest in breast cancer chemoprevention among older women without a history of breast cancer and to determine whether aging-related factors such as diminished life expectancy, increasing comorbidity and medication burden attenuate chemoprevention interest. Cross-sectional survey. University of Pennsylvania Health System. Four-hundred fifty-seven community-dwelling women aged 60-65 years old who were potentially eligible for breast cancer chemoprevention according to guidelines linking risk and eligibility to age. Interest in breast cancer chemoprevention, Gail model breast cancer risk, perceived breast cancer risk, breast cancer worry, self-reported health status and comorbidities, and self-reported perceived life expectancy. Of 457 participants, 11.2% reported being interested in taking chemoprevention, 40.9% reported no interest, and 47.9% reported being unsure about their interest in chemoprevention. Overall, interest in chemoprevention was not associated with individual Gail model breast cancer risk. In adjusted analysis, lack of interest among high-risk women was associated with low breast cancer worry and low perceived risk. Conversely, interest in chemoprevention among low risk women was associated with greater breast cancer worry. Age-related factors hypothesized to affect chemoprevention interest, including subjective life expectancy, increased comorbidity, and number of daily medications did not attenuate chemoprevention interest. Breast cancer worry and perceived breast cancer risk contribute to the lack of correlation between interest in breast cancer chemoprevention and objective breast cancer risk. Perceived life expectancy, increased comorbidity, and medication burden do not attenuate chemoprevention interest among older women.

Psychological adjustment among partners of women at high risk of developing breast/ovarian cancer

PurposeThe aim of the current research was to characterize psychological adjustment among partners of women at high risk of developing breast/ovarian cancer and to explore the relationship between women's and partners' adjustment. MethodsA study of 95 unaffected at-risk women and 95 partners was carried out using mailed, self-administered questionnaires with validated measures of psychological outcome. ResultsElevated levels of distress were noted in up to 10% of partners. High monitoring coping style and greater perceived breast cancer risk for their wife were associated with higher distress levels for partners. However, communicating openly with their wife and the occurrence of a recent cancer-related event in the woman's family were related to lower distress for partners. Partners' cancer-specific distress was positively related to their wives' distress. ConclusionAmong partners with elevated levels of distress, the ability to provide effective support to the at-risk women and participate appropriately in their decision making may be compromised. These partners are likely to benefit from targeted clinical interventions designed to reduce their distress levels. The findings emphasize the importance of considering partners of at-risk women in service provision and highlight the need for partners to obtain information and support specifically tailored to their needs.

Perceptions of breast cancer risk and cancer screening: A qualitative study of Young, female Hodgkin’s Disease survivors

Young female Hodgkins Disease (HD) survivors are at high risk for breast cancer following chest irradiation. We explored health perceptions, screening behaviors, and barriers of this population. Three focus groups and nine individual interviews (n = 22) were conducted. Women expressed significant misperceptions about breast cancer risk and screening. Screening barriers included avoidance, insurance issues, and lack of physician support. Female HD survivors would likely benefit from tailored education that links current beliefs with their previous cancer experience. Education about cancer risk may be more effective if delivered in a health-promoting rather than disease-detection framework.

Sociocultural Predictors of Breast Cancer Risk Perceptions in African American Breast Cancer Survivors

Although African American breast cancer survivors are at increased risk for developing breast cancer again, empirical data are not available on breast cancer risk perceptions in these women. This study characterized perceived risk of developing breast cancer in African American breast cancer survivors at risk for having a BRCA1 or BRCA1 (BRCA1/2) mutation and identified factors having significant independent associations with risk perceptions. Participants were 95 African American breast cancer survivors at an increased risk for having a BRCA1/2 mutation. Risk perceptions and sociodemographic, clinical, treatment, and sociocultural factors were collected during a structured telephone interview. Most women reported that they had the same or lower risk of developing breast cancer again compared with other women (53%); however, a substantial minority of women (47%) reported that they had a higher or much higher risk. Factors having significant independent associations with heightened risk perceptions included having a >or=10% prior probability of having a BRCA1/2 mutation [odds ratio (OR), 2.91; 95% confidence interval (95% CI), 1.09-7.72; P = 0.03] and more years of formal education (OR, 2.74; 95% CI, 1.02-7.36; P = 0.05). In addition, women who thought about the past a lot were three times more likely to report heightened risk perceptions compared with those who did not think about the past a lot (OR, 3.72; 95% CI, 1.45-9.57; P = 0.01). These results suggest that it may be important to ensure adequate risk comprehension among African American women as part of genetic counseling for inherited breast-ovarian cancer risk. Discussion of risk perceptions within the context of existing beliefs and values may facilitate this process.

Risk communication in completed series of breast cancer genetic counseling visits

Purpose: There is no consensus on how best to communicate risk in breast cancer genetic counseling. We studied risk communication in completed series of counseling visits and assessed associations with counselees' postcounseling risk perception and satisfaction.Methods: Pre- and postcounseling questionnaires and videorecordings of all visits were available for 51 affected and unaffected women from families with no known BRCA1/2 mutation, who fulfilled criteria for DNA testing. We developed a checklist for assessing risk communication and counselors' behaviors.Results: General risks were mainly communicated in initial visits, while counselee-specific risks were discussed mainly in concluding visits. The risks discussed most often were conveyed only numerically or qualitatively, and most were only stated positively or negatively. Counselors regularly helped counselees to understand the information, but seldom built on counselees' pre-existing perspective. Counselees' breast cancer risk perception after counseling was unrelated to whether this risk had been explicitly stated. The number of general risks discussed was negatively associated with counselees' satisfaction about counseling.Conclusion: Findings suggest that counselors' authority prevails over mutuality with individual counselees, in their communication about risks.

Tolerance for uncertainty and perceived risk among women receiving uninformativeBRCA1/2test results

Women who receive uninformative BRCA1/2 genetic test results face ongoing uncertainty about their future cancer risks. This article prospectively examined the influence of intolerance for uncertainty and perceived breast cancer risk on psychological distress following the receipt of uninformative BRCA1/2 test results. Sixty-four women who received uninformative BRCA1/2 mutation test results completed measures of Intolerance for Uncertainty, perceived breast cancer risk, and measures of cancer-related, genetic testing, and general distress. Cancer-related (DeltaR(2) = 0.18, P < or = 0.001), general (DeltaR(2) = 0.04, P < or = 0.05), and genetic testing distress (DeltaR(2) = 0.12, P < or = 0.01) were associated with intolerance for uncertainty at 1 month post-disclosure. The interaction of intolerance for uncertainty and breast cancer perceived risk predicted cancer-related (DeltaR(2) = 0.10, P < or = 0.001) and genetic testing distress (DeltaR(2) = 0.09, P < or = 0.01) at 6 months post-disclosure. Distress was highest among patients with highest perceived risk and intolerance for uncertainty, suggesting that those who have difficulty coping with their ambiguous risk are at risk for long-term distress. The clinical and research implications of these results are discussed.

Racial Differences in Perception of Breast Cancer Risk in Rural Southeast Georgia

Racial Differences in Perception of Breast Cancer Risk in Rural Southeast Georgia

Measuring Perceptions of Breast Cancer Risk

Accurate measurement of people's risk perceptions is important for numerous bodies of research and in clinical practice, but there is no consensus about the best measure. This study evaluated three measures of women's breast cancer risk perception by assessing their psychometric and test characteristics. A cross-sectional mailed survey to women from a primary care population asked participants to rate their chance of developing breast cancer in their lifetime on a 0% to 100% numerical scale and a verbal scale with five descriptive categories, and to compare their risk to others (seven categories). Six hundred three of 956 women returned the survey (63.1%), and we analyzed surveys from the 566 women without a self-reported personal history of breast or ovarian cancer. Scores on the numeric, verbal, and comparative measures were correlated with each other (r > 0.50), worry (r > 0.51), the Gail estimate (r > 0.26), and family history (r > 0.25). The numerical scale had the strongest correlation with annual mammogram (r = 0.19), and its correlation with the Gail estimate was unassociated with participants' sociodemographics. The numerical and comparative measures had the highest sensitivity (0.89-0.90) and specificity (0.99) for identifying women with very high risk perception. The numerical and comparative scale also did well in identifying women with very low risk perception, although the numerical scale had the highest specificity (0.96), whereas the comparative scale had the highest sensitivity (0.89). Different measures of women's perceptions about breast cancer risk have different strengths and weaknesses. Although the numerical measure did best overall, the optimal measure depends on the goals of the measure (i.e., avoidance of false positives or false negatives).

Spiritual Coping, Family History, and Perceived Risk for Breast Cancer—Can We Make Sense of it?

Differences in spiritual beliefs and practices could influence perceptions of the role of genetic risk factors on personal cancer risk. We explored spiritual coping and breast cancer risk perceptions among women with and without a reported family history of breast cancer. Analyses were conducted on data from 899 women in primary care clinics who did not have breast cancer. Structural equation modeling (SEM), linear, and logistic modeling tested an interaction of family history of breast cancer on the relationship between spiritual coping and risk perceptions. Overall analyses demonstrated an inverse relationship between spiritual coping and breast cancer risk perceptions and a modifying effect of family history. More frequent spiritual coping was associated with lower risk perceptions for women with positive family histories, but not for those with negative family histories. Results support further research in this area that could influence communication of risk information to cancer genetic counseling patients.

Duration of an Intervention's Impact on Perceived Breast Cancer Risk

This study explored risk perceptions after breast cancer risk appraisal. The study involved a randomized trial of Women's Health clinic patients (>or= 40 years old). Primary outcome was perceived breast cancer risk at baseline, 1 month, 6 months, and 18 months. Perceived breast cancer risks were higher than actual calculated risks at baseline. At baseline, 45% reported moderate/strong risk and 43% reported lower-than-average risk; 53% said that their risk was lower than 15%. Mean perceived lifetime risk was 31 out of 100. Throughout follow-up, the treatment group reported lower risks by all measures, as compared to controls. However, for African American women, perceived risk "out of 100 women" did not change. A brief health risk appraisal tends to lower breast cancer risk perceptions for at least 18 months, but the impact may vary by race/ethnicity. These findings could affect health behaviors, such as annual mammograms, which are influenced by perceived risk.

Breast Cancer-Specific Intrusions are Associated with Increased Cortisol Responses to Daily Life Stressors in Healthy Women Without Personal or Family Histories of Breast Cancer

Studies indicate that women fear breast cancer more than any other disease and that women's levels of breast cancer-specific intrusions are related to their perceived risk of breast cancer. Here, we explore possible biological consequences of higher breast cancer risk perceptions and intrusions in healthy women without personal or family histories of the disease. We hypothesized that women with higher perceived risk would have more intrusions about breast cancer, which would constitute a background stressor sufficient to increase hypothalamus-pituitary-adrenal axis (HPA) responsivity to daily stress. HPA responses to an ordinary life stressor (work) were assessed in 141 employed women (age = 37.2+/-9.2) without personal or family histories of breast cancer. Urinary cortisol excretion rates were assessed with timed sample collections at work, home, and during sleep. Repeated measures ANOVA revealed a significant Group by Time interaction with higher work cortisol levels in women with breast cancer-specific intrusions compared to women without intrusions (p < 0.02). Regression analyses revealed a significant association between risk perceptions and intrusions (p < 0.001). Regression analysis with intrusions and risk perceptions predicting work cortisol indicated a significant contribution of intrusions (p < 0.04), but not risk perceptions (p = 0.53). Overestimation of breast cancer risk is associated with higher levels of breast cancer-specific intrusions that can result in increased cortisol responsivity to daily stressors. This heightened responsivity could have long-term negative health implications.

"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

Variations in subjective breast cancer risk estimations when using different measurements for assessing breast cancer risk perception

Objective: To investigate whether different measurements for breast cancer risk perception can lead to variations in breast cancer risk estimations and to different conclusions about risk accuracy. Methods: Women with no history of breast cancer (N = 377) estimated their breast cancer risk on four different scales (percentage scale, visual analogue scale, 7-point scale, comparative scale). We examined the associations between the risk estimations and assessed women's confidence in risk judgements. Results: Women overestimated their breast cancer risk on the percentage and visual analogue scales. In contrast, judgements on the 7-point scale indicated a more adequate risk perception, whereas on the comparative scale women tended to underestimate their breast cancer risk. Women felt least confident in their judgement on the percentage scale and most confident using the comparative scale. Conclusions: Some scales for assessing breast cancer risk perception (e.g., percentages) might trigger increased uncertainty, which in turn may provoke risk estimations which do not accurately reflect women's actual views and feelings about their breast cancer risk. Thus, due to differences in confidence in risk judgements, different scales might lead to dissimilar risk estimations and thus to different and potentially invalid conclusions about subjective breast cancer risk concepts.

“Why take it if you don’t have anything?” breast cancer risk perceptions and prevention choices at a public hospital

Despite advances in breast cancer risk assessment and risk reduction technologies, little is still known about how high-risk women make sense of their risk and assess prevention options, particularly among minority and low-income women. Qualitative methods explore the complex meanings and logics of risk and prevention that quantitative approaches overlook. This study examined how women attending a high risk breast cancer clinic at a public hospital conceptualize their breast cancer risk and think about the prevention options available to them. Semi-structured interviews were used to gather data from 33 high-risk women (75% African American) between May and August 2004. Interview transcripts were analyzed for recurrent themes and patterns. Despite general awareness of their objective risk status, many women in this study reported they did not feel "high risk" because they lacked signs and symptoms of cancer. Risk was described as an experienced acute problem rather than a statistical possibility. Women also frequently stated that thinking about cancer might cause it to happen and so it is better not to "dwell on it." While screening was welcomed, women were generally skeptical about primary prevention. In particular, preventive therapies were perceived to cause problems and were only acceptable as treatment options for a disease. The body of ideas about risk and prevention expressed by this population differ from the medical model. These findings have implications for risk perception research as well as for the efficacy of risk communication and prevention counseling in clinical contexts.

Breast Cancer Risk Assessment and Risk Perception on Nurses and Midwives in Bornova Health District in Turkey

Risk perception is a significant component of awareness of breast cancer risks. It can be helpful to reduce deaths of breast cancer via increasing awareness risk level. This study aimed to discuss the level of perceived and calculated breast cancer risk and to provide data on the practice of breast self-examination and use of mammography among 215 nurses and midwives working in the 23 primary healthcare centers in Turkey. Participants were asked to assess their personal lifetime breast cancer risk by a 4-item Likert scale ("no risk," "usual," "moderate," and "strong" risk), which determined "perceived breast cancer risk." Gail model was used to assess the "calculated breast cancer risk," which was calculated by the tool provided by the National Cancer Institute, version 7. Perceived and calculated risk levels were compared. The relation between sociodemographic and risk factors with "perceived risk" was examined. In addition, the influence of perceived risk on breast cancer screening practice was also assessed. The level of perceived risk of nurses and midwives was higher than that of calculated risk. Considering the fact that participants were healthcare professionals, the use of breast self-examination and mammography practices as a preventive behavior by nurses and midwives was lower than expected. Implications are discussed with regard to breast cancer risk and preventive behavior.

Lack of Acknowledgment of Fruit and Vegetable Recommendations Among Nonadherent Individuals: Associations With Information Processing and Cancer Cognitions

Inadequate consumption of fruits and vegetables is regarded as an important behavioral risk factor for multiple types of cancer. Nevertheless, adherence with the National Cancer Institute (NCI) guidelines to eat between five and nine servings of fruits and vegetables per day is remarkably low. The current study explored the extent to which nonadherent respondents in a national survey (N = 5,625) listed fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk. We sought to determine whether respondents who listed fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk (hereafter referred to as “listers”) differed from respondents who did not list fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk (hereafter referred to as) “nonlisters” on measures of information processing and cancer cognitions. Nonlisters were more likely than listers to seek out cancer information but less likely to trust the information. The two groups did not differ in the amount of attention they paid to such information. Listers had lower absolute risk perceptions than nonlisters, but listers and nonlisters did not differ on measures of relative breast and colon cancer risk perceptions and worry for cancer in general. Female listers did perceive themselves to be at less relative risk for breast cancer than nonlisters. Respondents were more likely to list fruit and vegetable consumption as a cancer-risk reduction strategy for others than for themselves, suggesting a “double standard” in their beliefs. These findings suggest that communications designed to promote fruit and vegetable consumption need to account for biases in how nonadherent individuals respond to these communications.

Effects of counseling Ashkenazi Jewish women about breast cancer risk.

The goal of this study was to determine whether genetic counseling or psychosocial group counseling provided to Ashkenazi women can reduce breast cancer worry, cancer risk perception, and interest in having genetic testing. Women (N=211) were randomized to receive individual genetic risk counseling, to receive a group psychosocial group counseling, or to serve as a control group. The authors found that both counseling methods reduced cancer worry, lowered perceptions of breast cancer risk, and decreased interest in having genetic testing. Counseling can help women gain a more accurate perception of their risk, expose them to the benefits and limitations of genetic testing, and reduce their worry about cancer.