Cancer Risk Perception Research Articles

Thematic Analysis of Smokers’ Attitudes Towards Lung Cancer Screening Using Spiral Ct Scanning

Background: Spiral CT scanning can be used to screen current smokers who may be at higher risk of developing lung cancer. However, there is little understanding on whether smokers would be more likely to attend for lung cancer screening if this option were available. Methods: Semi-structured interviews with nine at-risk smokers were conducted. Results: The results of the thematic analysis showed that though most participants displayed a positive attitude towards lung cancer screening, they seemed to identify more with the barriers than the facilitators and would therefore not attend for screening. Two themes were identified: (1) Smokers’ beliefs and misconceptions and (2) Fear of screening outcomes. These encompassed participant’s lower cancer risk perceptions, fatalistic beliefs, lack of trust in health professionals and their fears associated with being screened and receiving a cancer diagnosis. Conclusion: Therefore, in order to maximize screening uptake, greater focus is needed on understanding how these barriers affect smokers’ decision-making processes before investment into a national screening program is made.

Risk and the importance of absent symptoms in constructions of the ‘cancer candidate’

Cancer is a disease that is imbued with notions of risk, with individuals expected to avoid ‘risky’ behaviours and act swiftly when symptoms indicating a risk of cancer emerge. Cancer symptoms, however, are often ambiguous and indicative of a number of other conditions, making it difficult for people to assess when symptoms may, or may not, be the result of cancer. Here, we discuss interview data from a study examining the symptom appraisal and help-seeking experiences of patients referred for assessment of symptoms suspicious of a lung or colorectal cancer in the North-East of England. We explore how individuals draw upon ideas about cancer risks to assess whether cancer may be a possible explanation for their symptoms and to inform their decisions about help-seeking. In our analysis, we applied the concept of candidacy to the data, to highlight how lay epidemiology shapes people’s perceptions of cancer risk, and their subsequent responses to it. We found that participants appraised their symptoms, and the likelihood that they may have cancer, in light of relevant information on risk. These sources of information related to lifestyle factors, family history of cancer, environmental factors, and importantly, the symptomatic experience itself, including the absence of symptoms that participants associated with cancer. The importance of experienced, and absent, symptoms was a core element of participants’ everyday constructions of the ‘cancer candidate’, which informed symptom appraisal and subsequent help-seeking decision-making.

Long-Term Adaptation Among Adolescent and Young Adult Children to Familial Cancer Risk.

It is important to examine adolescent and young adult (AYA) children's long-term psychosocial and behavioral adaptation to disclosure of maternal BRCA-positive carrier status (BRCA+) to inform approaches for familial cancer risk communication, education, and counseling. Mothers underwent BRCA genetic testing 1 to 5 years earlier. Group differences in AYAs' self-reported outcomes were analyzed by maternal health and carrier status, and child age and sex. A total of N = 272 AYAs were enrolled: 76.1% of their mothers were breast or ovarian cancer survivors and 17.3% were BRCA+. AYAs' cancer risk behavior (tobacco and alcohol use, physical activity) and psychologic distress levels did not vary by maternal status. In bivariate analyses, AYAs of cancer-surviving mothers believed themselves to be at greater risk for, and were more knowledgeable about, cancer than AYAs of mothers without cancer. AYAs of BRCA+ mothers were more concerned about cancer, held stronger beliefs about genetic risk, and placed a higher value on learning about genetics. In adjusted models, maternal cancer history (not BRCA+) remained associated with AYAs' greater perceptions of cancer risk (P = .002), and knowledge about cancer (P = .03) and its causes (P = .002). Disclosing maternal BRCA+ status did not influence children's lifestyle behavior or adversely affect quality of life long term. AYAs of BRCA+ mothers were more aware of and interested in genetic risk information. Such families may benefit from support to promote open communication about genetic testing choices.

Randomised trial of population-based BRCA testing in Ashkenazi Jews: long-term secondary lifestyle behavioural outcomes.

Ashkenazi-Jewish (AJ) population-based BRCA testing is acceptable, cost-effective and amplifies primary prevention for breast & ovarian cancer. However, data describing lifestyle impact are lacking. We report long-term results of population-based BRCA testing on lifestyle behaviour and cancer risk perception. Two-arm randomised controlled trials (ISRCTN73338115, GCaPPS): (a) population-screening (PS); (b) family history (FH)/clinical criteria testing. North London AJ-population. AJ women/men >18 years. prior BRCA testing or first-degree relatives of BRCA-carriers. Participants were recruited through self-referral. All participants received informed pre-test genetic counselling. The intervention included genetic testing for three AJ BRCA-mutations: 185delAG(c.68_69delAG), 5382insC(c.5266dupC) and 6174delT(c.5946delT). This was undertaken for all participants in the PS arm and participants fulfilling FH/clinical criteria in the FH arm. Patients filled out customised/validated questionnaires at baseline/1-year/2-year/3-year follow-ups. Generalised linear-mixed models adjusted for covariates and appropriate contrast tests were used for between-group/within-group analysis of lifestyle and behavioural outcomes along with evaluating factors associated with these outcomes. Outcomes are adjusted for multiple testing (Bonferroni method), with P< 0.0039 considered significant. Lifestyle/behavioural outcomes at baseline/1-year/2-year/3-year follow-ups. 1034 participants were randomised to PS (n= 530) or FH (n= 504) arms. No significant difference was identified between PS- and FH-based BRCA testing approaches in terms of dietary fruit/vegetable/meat consumption, vitamin intake, alcohol quantity/ frequency, smoking behaviour (frequency/cessation), physical activity/exercise or routine breast mammogram screening behaviour, with outcomes not affected by BRCA test result. Cancer risk perception decreased with time following BRCA testing, with no difference between FH/PS approaches, and the perception of risk was lowest in BRCA-negative participants. Men consumed fewer fruits/vegetables/vitamins and more meat/alcohol than women (P< 0.001). Population-based and FH-based AJ BRCA testing have similar long-term lifestyle impacts on smoking, alcohol, dietary fruit/vegetable/meat/vitamin, exercise, breast screening participation and reduced cancer risk perception.

The Clinical and Psychosocial Outcomes for Women Who Received Unexpected Clinically Actionable Germline Information Identified through Research: An Exploratory Sequential Mixed-Methods Comparative Study.

Background Research identifying and returning clinically actionable germline variants offer a new avenue of access to genetic information. The psychosocial and clinical outcomes for women who have received this ‘genome-first care’ delivering hereditary breast and ovarian cancer risk information outside of clinical genetics services are unknown. Methods: An exploratory sequential mixed-methods case-control study compared outcomes between women who did (cases; group 1) and did not (controls; group 2) receive clinically actionable genetic information from a research cohort in Victoria, Australia. Participants completed an online survey examining cancer risk perception and worry, and group 1 also completed distress and adaptation measures. Group 1 participants subsequently completed a semi structured interview. Results: Forty-five participants (group 1) and 96 (group 2) completed the online survey, and 31 group 1 participants were interviewed. There were no demographic differences between groups 1 and 2, although more of group 1 participants had children (p = 0.03). Group 1 reported significantly higher breast cancer risk perception (p < 0.001) compared to group 2, and higher cancer worry than group 2 (p < 0.001). Some group 1 participants described how receiving their genetic information heightened their cancer risk perception and exacerbated their cancer worry while waiting for risk-reducing surgery. Group 1 participants reported a MICRA mean score of 27.4 (SD 11.8, range 9–56; possible range 0–95), and an adaptation score of 2.9 (SD = 1.1). Conclusion: There were no adverse psychological outcomes amongst women who received clinically actionable germline information through a model of ‘genome-first’ care compared to those who did not. These findings support the return of clinically actionable research results to research participants.

Background: cigarette smoking is the greatest known risk factor for lung cancer, and people with different smoking status may process risk information differently. While psychological distress has been linked with smoking status, little is known about the

&#x0D; Background: cigarette smoking is the greatest known risk factor for lung cancer, and people with different smoking status may process risk information differently. While psychological distress has been linked with smoking status, little is known about the impact of distress on lung cancer perception or the moderating role of physical activity and race. This study explores the association of lung cancer perception and distress and investigates the effects of physical activity and race on that association.&#x0D; Methods: the study uses a national, biennial survey (the Health Information National Trends Survey) that was designed to collect nationally representative data on the American public’s need for, access to, and use of cancer-related information using a cross-sectional, complex sample survey design. Out of 5 586 participants, 1 015 were current smokers, 1 599 were former smokers, 2 877 were never smokers. Of the sample, 1 765 participants answered the lung cancer risk perception question and had no personal history of lung cancer. Statistical analysis contrasts smokers, former smokers, and never smokers to examine the association of lung cancer perception and distress and the moderating role of physical activity and race.&#x0D; Results: distress and lung cancer risk perception were significantly positively associated (p value &lt; 0.001). Respondents who were current smokers and were distressed had very high odds of agreeing that they have a somewhat high chance (odds ratio=900.8, CI: 94.23, 8 611.75; p value &lt; 0.001) or a very high chance (odds ratio=500.44 CI: 56.53, 4 430.02, p value &lt; 0.001) of developing lung cancer in the future as compared to not distressed never smokers. However, race and physical activity status did not significantly affect perception of risk. Perceptions of risk are important precursors of health change.&#x0D; Conclusions: elevated distress level and higher perceived risk, in addition to physical activity status and race, could potentially be used to develop targeted interventions, such as tailoring quitting support for smokers at elevated distress levels, which may enhance success rate of quitting smoking and staying quit.&#x0D;

Cervical cancer perceived risks and associated factors among women in Saudi Arabia: A cross-sectional study.

Examining the risk perception of one of the most life-threatening cancers among women, such as cervical cancer, will guide the development of targeted advocacy and educational programs to reduce the burden of the disease. The current study investigated cervical cancer perceived risks and associated factors among Saudi women. A cross-sectional study was conducted through a social media-based survey, which conveniently targeted 1085 Saudi women in Najran city. The survey questionnaire consisted of four parts: basic sociodemographic data, cervical cancer knowledge quiz, attitude scale, and risk perception Scale. The present study confirmed that 57.4% of the study participants had high-risk perception regarding cervical cancer. Among the study participants, 42.6% had a low perception of the risk of cervical cancer, 57.3% had unsatisfactory knowledge, while 59.4% had a positive attitude (59.4%) towards cervical cancer prevention and its screening. The binary logistic regression proved that the positive significant factors associated with risk perception were higher education [AOR=3.105 (1.300 - 7.418), p=0.011], increasing age [AOR=1.191 (1.043-1.359), p=0.005], longer duration of marriage [AOR=3.123 (1.112 - 8.767), p=0.031], having family history of cancer/cervical cancer [AOR=4.498 (1.119 - 18.085), p=0.034], satisfactory knowledge [AOR=2.304 (1.289 - 4.116), p=0.005], and positive attitude [AOR=3.248 (2.532 - 4.166), p=0.000]. We conclude that more than half of the women in Najran city had high cervical cancer-related risk perception while more than two-fifths perceived low risk with unsatisfactory knowledge and a positive attitude. These results highlight the pressing need to develop cervical cancer health education programs to foster risk perception as a driving strategy for the prevention of cervical cancer in Saudi Arabian women.

The Thoughts, Feelings and Behaviours of Young Women Who Familial Cancer History: A Qualitative Study

Purpose: This study purpose was to determine the thoughts, feelings and behaviours of young women who familial cancer history.&#x0D; Material and Methods: This was a qualitative study. The criterion sampling method, which is one of the purposeful sampling methods, was used to determine the study group of the study. The study was conducted at a state university in Turkey. Between April and May 2019, 12 volunteer young women aged 17-24 were included in the study.&#x0D; Results: The qualitative data were subjected to content analysis, and the main themes were determined. In the content analysis of the interviews, 7 main themes were determined: fear, coping methods, risk perception, carcinophobia, spirituality, healthy lifestyle behaviors, role change. It was observed that the participants frequently used statements that genetic predisposition and stress are risk factors for cancer, cancer negatively affects roles and responsibilities, and they believed the importance of early diagnosis. In this study, young women with a family history of breast and/or gynecological cancer were found to have higher cancer risk perceptions. &#x0D; Conclusion: The familial cancer history, especially when managed well in high-risk populations, contributes to individuals to acquire healthy lifestyle behaviors and gain the ability to make conscious decisions. Healthcare professionals can play vital roles in presenting needed knowledge about breast / gynecological cancers and raising awareness in women.

Change in breast cancer risk perception related to perceived COVID-19 risk: A WISDOM sub-population analysis.

e24135 Background: Obstacles to access to care due to the perceptions of the risk posed by COVID-19 have led to unprecedented disruptions in cancer care. Yet, little is understood about whether perceived COVID-19 risk influences perceptions of cancer risk. We examined how COVID-19 risk perception was associated with perceptions of breast cancer risk over one year of the pandemic among women enrolled in the WISDOM study, a PCORI-funded pragmatic trial testing risk-based cancer screening that began before the pandemic. Methods: We conducted four longitudinal surveys among the 13,002 women enrolled in the WISDOM study from May - December 2020. Responses from 8,285 women are eligible for inclusion in this analysis leading to a total sample size of 16,859 survey responses. Surveys were conducted online and asked women’s perceived lifetime chance of developing breast cancer (0-100%). COVID-19 risk perception was reported on a 5-point scale from Very Low to Very High. We computed the difference between breast cancer risk perception at each COVID-19 survey to pre-COVID breast cancer risk perception, measured as a secondary aim of the WISDOM study, and compared that to COVID-19 risk perception at each time point. Results: Across the four survey waves, most women perceived low COVID risk: 29% very low, 42% moderately low, 23% neither high nor low and 6% high or very high. Overall, breast cancer risk perception declined for those with very low COVID-19 risk perception and rose for women in the highest levels of COVID-19 risk perception. However, changes in breast cancer risk perception associated with COVID risk perception were small. For example, in survey wave 4, breast cancer risk change was -2.4% very low, -1.4% low, 2.5% not high or low and 3.1% high or very high. (Table). Conclusions: Among women participating in a pragmatic trial testing risk-based cancer screening, COVID risk perception had a small relationship with change in breast cancer risk perception. Change in breast cancer risk perception paralleled COVID-19 risk perception. This calls for exploration of the underpinnings of these risk changes and may have implications for changes in cancer screening behavior related to COVID-19.[Table: see text]

Genetic clinicians' confidence in BOADICEA comprehensive breast cancer risk estimates and counselees' psychosocial outcomes: A prospective study.

Counseling for familial breast cancer focuses on communicating the gene test result (GENE) to counselees, but risk prediction models have become more complex by including non‐genetic risk factors (NGRF) and polygenic risk scores (PRS). We examined genetic clinicians' confidence in counseling and counselees' psychosocial outcomes, using the BOADICEA risk prediction tool with different categories of risk factors as input. A prospective observational study in Dutch, French and German genetic clinics was performed including 22 clinicians, and 406 of 460 (88.3%) eligible cancer‐unaffected women at high breast cancer risk assessed at pre‐test and 350 (76.1%) at post‐test. We performed multilevel analyses accounting for the clinician, and counselees' characteristics. Overall, risk estimates category by GENE versus GENE+ NGRF, or GENE+NGRF+PRS differed in 11% and 25% of counselees, respectively. In multilevel analyses, clinicians felt less confident in counseling when the full model provided lower breast cancer risks than GENE (i.e., in 8% of cases). Older counselees expressed higher breast cancer risk perception and worries about the hereditary predisposition when the full model provided higher breast cancer risks than GENE only. Genetic clinicians appear confident with breast cancer risk comprehensive models, which seem only to affect perceptions of older counselees.

139P Breast cancer risk estimation (CanRisk tool) and perception in unaffected women with family history of breast cancer

Improvement of the accuracy of risk estimation is one of the most challenging goals of cancer risk assessment for women at risk of familial breast cancer (BC) without germline pathogenic variants in known susceptibility genes. Comprehensive risk prediction models such as CanRisk achieve the highest risk stratification by considering a full set of established risk factors. Our aims were: (i) to assess the difference between women´s risk perception and CanRisk-based risk prediction; and (ii) to compare CanRisk-based BC risk estimation with and without the incorporation of breast density (BD).

Attitudes and interest in incorporating BRCA1/2 cancer susceptibility testing into reproductive carrier screening for Ashkenazi Jewish men and women.

Pathogenic variants in the BRCA1 and BRCA2 (BRCA1/2) genes are associated with elevated cancer risks in men and women. Due to a founder effect, Ashkenazi Jewish individuals are at higher risk for carrying three specific BRCA1/2 pathogenic variants. There have been recent calls for population screening in this population because many carriers do not have family histories suggestive of hereditary cancer. One approach could be to integrate optional BRCA1/2 testing into routinely offered reproductive carrier screening for recessive and X-linked disorders. However, the differing goals of these types of testing (i.e., personal health risks versus family planning) raise questions about the implications for patient education and informed consent. To this end, we aimed to determine interest, attitudes, and preferences regarding integrating such testing by electronically surveying 331 Ashkenazi Jewish participants in JScreen — a national, not-for-profit, at-home carrier screening program focused on genetic risks in Jewish communities. We found that while 41% of participants had plans to pursue BRCA1/2 testing, 93% would have opted for such testing if offered as an add-on to reproductive carrier screening. This was particularly true of those with higher perceived cancer risk and more positive attitudes toward genetic testing. With respect to preferences about delivery of this service, more than 85% of participants preferred remote (telephone, print, or web-based) genetic education rather than traditional genetic counseling. These results suggest that offering optional BRCA1/2 testing within the context of reproductive carrier screening might provide opportunities for cancer prevention without overburdening scarce genetic counseling resources.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12687-022-00590-3.

Risk perception and disease knowledge in attendees of a community-based lung cancer screening programme

ObjectivesIn England, a risk-based approach is used to determine eligibility for lung cancer screening. Ensuring effective communication and counselling of risk is therefore increasingly important. In this study, we explore the perception of lung cancer risk in attendees of a community-based screening service, located in socio-economically deprived areas of Manchester. We analyse responses based on demographic variables, calculated risk score and screening eligibility. Materials and MethodsThe Manchester Lung Health Check (LHC) programme invited ever smokers, age 55–80, to a lung cancer risk assessment in which their 6-year risk was calculated (using the PLCOM2012 model). Those at high risk (PLCOM2012 score ≥ 1.51%) were eligible for low dose CT (LDCT) screening. Prior to their assessment, attendees were invited to complete the study questionnaire, which assessed absolute and comparative risk perception, disease knowledge (incidence, survival, and risk factors), lung cancer specific worry, and mental health. Results371 participants completed the questionnaire; 66% (n = 243) had linked clinical data. Perceived absolute risk was markedly higher than calculated risk (median: 20% vs. 1%; p < 0.001) and higher in women than men (25% vs. 15%; p = 0.001). There was no correlation between perceived absolute and calculated risk. Overall, 30% classified themselves at higher, and 21% at lower, lung cancer risk compared to others their age. Median PLCOM2012 score increased with perceived comparative risk (p = 0.004). Those eligible for screening were more likely to: classify themselves at higher comparative risk (41% vs. 21%; p < 0.0001), report lung cancer-specific worry (27% vs. 10%; p = 0.001) and have indications of depression (20% vs. 10%; p = 0.05). Family history of lung cancer was significantly associated with higher comparative risk (adjOR 4.03, 95%CI 1.74–9.3; p = 0.001). ConclusionEmploying comparative rather than absolute risk may assist risk counselling. Further research is required to determine the optimal approach to risk communication in this setting.

Psychological Determinants of Men's Adherence to Cascade Screening for BRCA1/2.

BRCA1/2 germline mutations predispose carriers to an increased risk of breast, ovarian, prostate, pancreatic, and skin cancer. Men and women are equally likely to pass on or inherit the pathogenic variant. However, there is evidence that male relatives are less involved in cascade screening than female ones. At the same time, little attention has been given to the research on psychological determinants of men’s adherence to cascade screening in BRCA1/2-positive families. Applying some principles of the Health Action Process Approach model, the present research tested a model of relationships on the adherence to BRCA1/2 cascade testing guidelines. The sample comprised 115 men’s first-degree relatives of women with verified germline mutations (Mage = 41.93; SD = 17.27). A pre–post test design was applied. Significant associations emerged between the intention to uptake BRCA1/2 genetic testing and age, parental status, breast cancer risk perception, self-referred outcome expectancies, perceived benefit, coping self-efficacy, and planning. Higher perceived benefit predicted increases in intention, and higher intention and coping self-efficacy predicted increases in planning. Intention was a positive total mediator of the relationship between benefit and planning. On a theoretical level, our findings partially supported the Health Action Process Approach as a valuable model based on which interventions could be developed in the context of cascade screening for BRCA1/2 genetic testing. Those results supported the importance of integrated genetic counselling sessions with a strict collaboration between geneticists and psychologists together with interventions planned to increase men’s self-monitoring ability to support their self-efficacy.

Correlates of U.S. Young adults’ awareness of alcohol use as a behavioral risk factor for cancer

Although alcohol increases the risk of cancer, awareness of alcohol-related cancer risks is low. Alcohol use is prevalent among young adults, and understanding factors associated with awareness and perceptions of alcohol-related cancer risks in this group is critical for cancer prevention efforts. We examined the demographic, tobacco, and alcohol related correlates of young adults’ awareness and perceptions of alcohol as a behavioral risk factor for cancer. We completed a secondary analysis of data collected in February 2020 in the U.S. from 1,328 young adults (ages 18–30) who completed a cross-sectional online survey. Participants reported (1) awareness of alcohol as a risk factor for cancer and (2) perceived risks of serious disease such as cancer. We analyzed demographic characteristics, alcohol use, and tobacco use associated with these outcome variables using multivariable regression. Overall, 18.5% of participants believed that alcohol does not increase cancer risk. Perceived cancer risk associated with alcohol use was moderate (M 3.2, SD 1.6, 1–7 scale). In multivariable analysis, awareness of risk was significantly higher among those with higher socioeconomic status. Perceived risk was significantly greater among those with higher socioeconomic status, higher alcohol consumption, and a history of tobacco use. These findings indicate research is warranted to better understand awareness of alcohol as a behavioral risk factor for cancer and associated beliefs in subgroups of young adults to help guide the development of interventions to raise awareness of the risks of cancer associated with alcohol use.

Korean American Immigrant Women's Perceived Breast Cancer Risk and Prevention Beliefs: A Qualitative Study.

With the goal of informing culturally appropriate intervention strategies, the purpose of this qualitative study was to understand the Korean American immigrant women's (KAIW) perceptions of breast cancer risk and how their perceived risk, along with normative breast cancer prevention beliefs, shaped their attitudes toward mammography. Semi-structured individual interviews were conducted with 30 Korean women in Los Angeles County, Los Angeles, California. Braun and Clarke's thematic analysis was used to code and analyze interview data. Two major themes were identified: (a) perceived risk of breast cancer and attitudes to prevention (e.g., worried and using all means of prevention) and (b) influences on attitudes to breast cancer prevention (e.g., family members and friends' cancer experiences). Breast cancer prevention interventions for KAIW should target perceived breast cancer risk, social factors such as women's family roles and social networks, and health information evaluation skills.

OP012: Perceptions of breast and ovarian cancer risk and genetic testing among Non-Hispanic Black women

Non-Hispanic Black (NHB) women experience health disparities from familial and hereditary breast and ovarian cancer (HBOC) compared to other racial and ethnic groups, including 40% higher mortality from breast cancer compared to non-Hispanic White women. One potential factor in these disparities includes lower uptake of HBOC genetic testing. This study explores potential factors for the lower use of HBOC genetic testing in NHB women and their families. Understanding these factors is critical to improving uptake of HBOC testing in the NHB community and improving HBOC racial and ethnic health disparities. A national sample of NHB women with personal or family history of HBOC were recruited through patient support organizations, historically Black colleges and university sororities, professional organizations for women of African descent, and snowball sampling. Participants were interviewed using an interview guide developed by content experts and a community advisory board. Interviews were audio recorded and transcribed verbatim. Interview transcripts were qualitatively analyzed using NVivo12 according to the principles of grounded theory. Sixty-one NHB women with personal (n=37, breast; n=6, ovarian) or family history (n=14, breast; n=2, ovarian; n=2 breast/ovarian) of HBOC participated in a qualitative interview. Participants reported on their own awareness of their family history of HBOC prior to their own diagnosis and how this informed their assessment of their pre-diagnostic risk of HBOC. The impact of family culture and cohesion, including perceptions of a familial ‘culture of silence’ around the sharing of personal or family medical history were also identified as potential barriers to awareness of HBOC risk. Thirty participants with a personal history and seven participants with family history received HBOC genetic testing upon recommendation of their provider or following their own request. Those that declined HBOC genetic testing described misperceptions of HBOC inheritance or expressed a belief that such testing would not be personally beneficial. Participants were also asked to describe family members’ interest in cascade testing and their reasons for accepting or declining HBOC genetic testing. Many participants felt that their daughters would be interested in HBOC genetic testing, but that siblings and other extended family members would decline out of belief that the results would have limited personal utility to themselves and/or their offspring or that a potential positive result would result in distress and life-long worry. Family members’ education status and views on healthcare were also thought to be important factors in their decision. This study is the largest qualitative study of its kind in NHB women with a personal or family history of breast and/or ovarian cancer. These findings suggests that there are significant barriers to HBOC genetic testing in the NHB community, including cultural factors influencing risk perception and the uptake of cascade testing. Culturally sensitive community outreach on the disparate impact of breast and ovarian cancer and how genetic testing may improve NHB cancer outcomes may improve uptake of HBOC genetic testing among at-risk NHB families.

Abstract P3-01-16: Screening for genetic risk at the time of mammography

Abstract Introduction: Approximately, 10-15% of breast cancers may be hereditary. Early identification of elevated genetic risk may decrease morbidly and mortality associated with breast cancer for this population by enabling timely implantation of optimized screening techniques. Reaching out to women with breast cancer risk assessment at the time of mammography may provide an opportunity to connect risk perception with risk reduction action. We hypothesized that women receiving a high-risk assessment at the time of mammography would facilitate entry to genetic counseling. Methods: In September 2019, Jefferson Health New Jersey (JHNJ) started utilizing a tool to screen individuals for an increased risk for hereditary breast cancer syndromes (family history screening 7; FHS-7) to all women presenting for mammography at its three breast imaging centers. The FHS-7 tool was embedded into the electronic medical record system and would generate a score based on 7 questions related to a patient’s family history of breast, ovarian and bowel cancer. Women who were identified at elevated risk (FHS-7 scores ≥1) were asked by the mammography technician prior to performing the screening mammogram for their permission to be contacted by a high-risk counselor for a formal high-risk assessment and potential genetic counseling/testing. In March 2020, nearly all cancer screening services shut down with the COVID-19 pandemic. Services re-opened in June 2020. We report on our experience in three-time frames: September 2019-February 2020; March 2020-May 2020, and June 2020-present. Results: From September 2019-February 2020: 3,169 mammograms and FHS-7 screenings were performed. 44 had scores ≥1 (1.4%). 4 (9%) agreed to be contacted for an appointment with a high-risk counselor. Of these, 2 had previously met with genetics. No additional appointments were scheduled. From March 2020-May 2020, 576 mammograms and FHS-7 screenings were performed. 9 had scores ≥1 (1.6%). None agreed to be contacted for an appointment with a high-risk counselor. Two appointments had previously been completed. From June 2020-June 2021, 9,131 mammograms and FHS-7 screenings were performed. 240 had scores ≥1 (2.6%). 22 (9%) agreed to be contacted for an appointment with genetics. 11 appointments had previously been completed. 8 (73%) were completed as a consequence of this direct outreach. Conclusion: Although our work was interrupted by the COVID-19 pandemic, screening for hereditary risk at the time of mammography may be an effective way of facilitating referrals for genetic counseling/testing for high-risk patients. Consent to be contacted for a formal high-risk assessment was consistent at 9% pre-mammography closure and post-mammography re-opening. Consent to be contacted for genetics is likely to be associated with breast cancer risk perception. Future Directions: We are planning an educational intervention regarding the FSH-7 risk assessment tool and a positive score’s association with the risk of hereditary breast cancer syndromes, as well as the benefits of optimized screening techniques depending on a patient’s life-time risk of developing breast cancer. We anticipate that this will likely result in greater acceptance of a formal high-risk assessment for this at-risk population. Citation Format: Jason Shames, Dina Alnabulsi, Olivia Trachtenberg, AnaMaria Lopez. Screening for genetic risk at the time of mammography [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-01-16.

Analysis of the components of cancer risk perception and links with intention and behaviour: A UK-based study.

Risk perception refers to how individuals interpret their susceptibility to threats, and has been hypothesised as an important predictor of intentions and behaviour in many theories of health behaviour change. However, its components, optimal measurement, and effects are not yet fully understood. The TRIRISK model, developed in the US, conceptualises risk perception as deliberative, affective and experiential components. In this study, we aimed to assess the replicability of the TRIRISK model in a UK sample by confirmatory factor analysis (CFA), explore the inherent factor structure of risk perception in the UK sample by exploratory factor analysis (EFA), and assess the associations of EFA-based factors with intentions to change behaviour and subsequent behaviour change. Data were derived from an online randomised controlled trial assessing cancer risk perception using the TRIRISK instrument and intention and lifestyle measures before and after communication of cancer risk. In the CFA analysis, the TRIRISK model of risk perception did not provide a good fit for the UK data. A revised model developed using EFA consisted of two separate “numerical” and “self-reflective” factors of deliberative risk perception, and a third factor combining affective with a subset of experiential items. This model provided a better fit to the data when cross-validated. Using multivariable regression analysis, we found that the self-reflective and affective-experiential factors of the model identified in this study were reliable predictors of intentions to prevent cancer. There were no associations of any of the risk perception factors with behaviour change. This study confirms that risk perception is clearly a multidimensional construct, having identified self-reflective risk perception as a new distinct component with predictive validity for intention. Furthermore, we highlight the practical implications of our findings for the design of interventions incorporating risk perception aimed at behaviour change in the context of cancer prevention.

Perceptions of Anal Cancer Risk Among HIV-Positive and High-Risk HIV-Negative Women.

Women living with HIV (WLWH) have a greater risk of anal cancer than women without HIV; however, there are limited studies that examine awareness of anal cancer risk among WLWH and "high-risk" HIV-negative women. This study examines risk factors for anal cancer, perceptions of risk for anal cancer, and perceptions of anal cancer screening among a cohort of WLWH and high-risk HIV-negative women. From the Atlanta, GA, and Bronx, NY, sites of the Women's Interagency HIV Study, 155 WLWH and HIV-negative women were enrolled and the Champion Health Belief Model Scale questionnaire measuring risk perceptions to anal cancer was administered to each participant. The WLWH perceived anal cancer to be less serious and perceived facing fewer barriers to anal cancer screening than HIV-negative women (both p = .01). Older women (≥50 years) felt that they had less barriers to anal cancer screening (p = .047). Moreover, women who had less than a high school education felt more susceptible to anal cancer (p = .001), as did women who reported a history of anal intercourse (p = .017). Despite being at an increased risk for anal cancer, perceptions of susceptibility to anal cancer and seriousness of anal cancer were low among WLWH. These findings highlight opportunities for provider and patient educational interventions to improve awareness of anal cancer risk among WLWH.