Perceived Breast Cancer Risk Research Articles

Willingness of Women at Increased Risk of Breast Cancer to Participate in Prevention Trials.

The factors affecting women's willingness to participate (WTP) in breast cancer (BC) prevention trials are poorly understood. This study aimed to identify the characteristics of interventions associated with a higher WTP among high BC risk women. Women who self-identified as being at an increased risk of BC were recruited to a cross-sectional study of WTP in BC prevention trials. Responses were dichotomized into more willing (a lot and moderately) and less willing (some, a little, and not at all), and responses were compared by patient characteristics and intervention type. Of 143 participants, 81.2% (116) completed ≥30% of a Likert-type scale questionnaire on WTP in various intervention types for BC prevention. Overall, WTP in BC prevention studies was high, with 82.7% more willing, including 69.0% and 70.7%, respectively, for unspecified physical activity and dietary interventions. WTP differed significantly by the duration of diet-based and physical activity behavior change interventions: decreasing with 12- versus 3-month diet-based interventions (P < .0001) and decreasing for 1 hour versus 30 minutes of low-intensity exercise/day (P < .0001). For interventions involving medication, only 18.1% expressed being more willing to participate, and WTP decreased significantly when side effects were presented. WTP was influenced by BC risk gene mutation status, with WTP among gene carriers higher compared with nongene carriers (52.6% v 30.2%, P = .018). WTP in BC prevention trials was the highest for women with known genetic risk and for interventions involving a behavior change. Medications with side effects had the lowest WTP. For behavior change, WTP was negatively influenced by intervention duration beyond a few months, indicating that individual perception of BC risk and inconvenience strongly influence WTP.

Patient-reported outcomes, and perceptions and knowledge about recurrence in women with hormone receptor-positive breast cancer.

Over half of hormone receptor-positive (HR+) breast cancer recurrences occur >5years from diagnosis, however, little is known about well-being or breast cancer risk perceptions and knowledge in long-term HR+ breast cancer survivors. From 1/2021 to 1/2022, we surveyed patients with a history of stage II/III, HR+ breast cancer, ≥5years from diagnosis, without recurrence about concerns and perceptions related to their diagnosis and recurrence risk, physical and emotional health, knowledge, and risk reduction. Logistic regression identified factors associated with overestimation of 5-10year distant recurrence risk. Among 166 women, median age at diagnosis was 51, 2.4% were Black and 1.2% Hispanic; 19.3% did not have a college degree. Median time from diagnosis was 10years (range: 5-23). Median PROMIS anxiety (53; range: 37-73), physical (51, range: 32-68), and mental (51, range: 25-68) scores were similar to population norms (score of 50). 40% of women estimated metastatic recurrence risk to be ≥20% 5-10years post-treatment; patients without a college degree were more likely to overestimate this risk (multivariable prevalence odds ratio: 3.69, 95% confidence interval: 1.49, 9.18). Only 17% correctly indicated HR+ breast cancer as having a higher risk of recurrence after 5years; over one-third inaccurately responded that alcohol in moderation decreases recurrence risk. While physical and emotional health were comparable to the general population, many survivors harbored inaccurate risk perceptions and knowledge. The association between lower educational attainment and risk overestimation underscores the importance of attention to literacy and numeracy when developing interventions to improve risk communication.

Abstract PO2-25-09: The hidden costs of beauty: An evaluation of breast cancer risk for Black women

Abstract The Black identity, hair product use, and breast cancer scale (BHBS) was developed and previously validated to evaluate the relationship between identity, hair product use, and breast cancer risk for Black women. Black women are disproportionately affected by breast cancer compared to other racial/ethnic groups, with a mortality rate of 40% higher than all other groups. Endocrine Disrupting Chemicals (EDCs) are present in many hair care products and have been linked to several health issues including breast cancer. Due to these health inequities and the complexity of how cultural norms shape Black women’s hair product usage, the purpose of this study was to assess the reliability of the BHBS for intervention planning and evaluate the hazard scores of hair products used by Black women. Methods: Participants were recruited using purposive convenience sampling techniques. The 11-item BHBS includes two subscales: five items measuring sociocultural perspectives about hair and identity (S1) and six items assessing perceived breast cancer risk related to hair product use (S2). To determine reliability, the BHBS was administered twice over a three-week period with sociodemographic factors obtained in the initial data collection phase. All statistical analyses, including descriptive statistics and test-retest reliability (Pearson correlations) were conducted using SPSS version 26. The Environmental Working Group's (EWG's) Skin Deep® database was used to determine hazard scores of hair products used by participants. Products are rated on a 10-point scale with low (0-2), moderate (3-6), and high hazard (7-10) scores. Results: Twenty-three (86.9% African, African American &amp; Caribbean; 13% multiracial) female participants completed the study. Their age ranged from 18-63 years (30.78, SD= 15.40), 47.8% reported an income of less than $25,000, and 34.8% completed some college education. Both subscales demonstrated highly significant and strong reliability (S1: r=.82, p&amp;lt; .001; S2: r=.88, p&amp;lt; .001). Participants primarily used conditioners (91.3% used wash out and 60.9% used leave-in), and professional hair dyes (34.8%). There was also a high frequency of non-use (91.3%) of do-it-yourself relaxers and hair dye kits. We evaluated 40 products across three categories including wash out conditioners, leave-in conditioners and other hair products (e.g., styling gels, shampoo, and hair oils), of which most had a moderate hazard rating of 5 denoting ingredients of health concerns (e.g., parabens, fragrance, and phenoxyethanol). Additionally, of the 22 company brands analyzed, only 10 (45%) are Black owned or founded. Conclusions: The BHBS is a valid and reliable instrument to assess sociocultural perspectives about hair, identity and perceived breast cancer risk. Black women use hair products including relaxers, hair dyes, and conditioners that contain EDCs that may be harmful to their health including risk for breast cancer. The BHBS will be used to evaluate psychosocial interventions that address the unique needs of Black women including exposure to EDCs from hair product use and breast cancer risk. Citation Format: Nicole Sarkaria, Marissa Ericson, Abigail Lopez, Dede Teteh. The hidden costs of beauty: An evaluation of breast cancer risk for Black women [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-25-09.

IJCM_128A: Understanding the Breast Cancer Knowledge, Screening practises and Needs among the women in rural South India: A Community-based mixed method study.

Background: Breast cancer (BC) is the leading cancer in India among women accounting for 13.5% of all cancer cases. One of the leading causes of high breast cancer deaths is poor awareness about risk factors, symptoms and screening leading to the late presentation at an advanced stage. Objectives: 1. To understand the knowledge of breast cancer symptoms and risk factors, perceptions and practises of breast cancer screening. 2. To do a need assessment of the people in the community regarding screening of breast cancer. Methodology: A community-based mixed method study was conducted at Chengalpattu, Tamil Nadu and primary data was collected from 401 women aged 18-60 years. Structured questionnaire was used to collect quantitative data to assess the knowledge of breast cancer. The need assessment on screening was done by Focus group discussions (FGD). Mean, median, proportions and chi-square test were used to analyse quantitative data and thematic content analysis for qualitative data. Results: The study found that 71.3% of the women were aware of breast cancer. The women who were aware of breast cancer considered lump in breast (78.3%), pain in one breast (66%) as the common symptoms. Women who were aware of breast cancer reported early menarche (16.8%), late menopause (15.4%), nulliparity (20%) and family history of cancer (49%) as the risk factors of breast cancer. 65% of the women were aware of at least one of the methods of breast cancer screening. More awareness programs, organising screening camps in the village, reducing the cost of screening tests were some of the needs addressed during the FGD. Conclusion: Knowledge of symptoms, risk factors and screening practises of breast cancer were low which necessitates the enhancement of knowledge on breast cancer to reduce the burden in the community.

Attitudes towards risk-stratified breast cancer screening: a population-based survey among 5,001 Danish women

BackgroundThe individual woman’s risk of being diagnosed with breast cancer can now be estimated more precisely, and screening can be stratified accordingly. The risk assessment requires that women are willing to provide a blood test, additional personal information, to know their risk, and alter screening intervals. This study aimed to investigate Danish women’s attitudes towards risk-stratified breast cancer screening.MethodsAn online, cross-sectional survey was conducted among Danish women aged 52–67 years. We used logistic regression analyses to assess how personal characteristics were associated with the women’s attitudes.Results5,001 women completed the survey (response rate 44%) of which 74% approved of risk estimation to potentially alter their screening intervals. However, only 42% would accept an extended screening interval if found to have low breast cancer risk, while 89% would accept a reduced interval if at high risk. The main determinants of these attitudes were age, education, screening participation, history of breast cancer, perceived breast cancer risk and to some extent breast cancer worry.ConclusionThis study indicates that women are positive towards risk-stratified breast cancer screening. However, reservations and knowledge among subgroups of women must be carefully considered and addressed before wider implementation of risk-stratified breast cancer screening in a national program.

Breast Cancer Risk Perceptions Among Underserved, Hispanic Women: Implications for Risk-Based Approaches to Screening.

Understanding factors that shape breast cancer risk perceptions is essential for implementing risk-based approaches to breast cancer detection and prevention. This study aimed to assess multilevel factors, including prior screening behavior, shaping underserved, Hispanic women's perceived risk for breast cancer. Secondary analysis of survey data from Hispanic women (N = 1325, 92% Spanish speaking, 64% < 50) enrolled in a large randomized controlled trial. Analyses were performed in two cohorts to account for the role of age on screening guideline recommendations (< 50 and 50 +). For each cohort, we examined differences in three common measures of perceived risk of breast cancer (percent lifetime, ordinal lifetime, comparative) by participant factors with chi-square or Kruskal-Wallis tests, as appropriate. Multivariate analyses examined the association between mammography history with percent perceived lifetime risk (outcome > 10 vs ≤ 10%). Overall, 75% reported a lifetime risk between 0 and 10%, 96% rated their ordinal risk as "not high," and 50% rated their comparative risk as "much lower." Women < 50 with a family history of breast cancer reported significantly higher levels of perceived risk across all three measures. Among women 50 + , those reporting lower levels of perceived risk were significantly more likely to be Spanish speaking. No significant association was observed between mammography history and percent lifetime risk of breast cancer. Factors shaping breast cancer risk perceptions differ by age. Prior screening may play less of role in constructing risk perceptions. Research is needed to develop culturally and linguistically appropriate strategies to improve implementation of risk-based screening.

An investigation of the relationship between female university students' breast cancer risk factors and their health beliefs about breast self-examination.

The purpose of this study is to determine the relationship between female university students' breast cancer risk factors and their health beliefs about breast self-examination (BSE). The sample of this descriptive and correlational study was 389 female students who were determined by stratified sampling method. Data were collected through the Socio-demographic Characteristics and Breast Cancer Risk Factors Determination Form and the Champion's Health Belief Model Scale (CHBMS). Data obtained from the study were analysed using SPSS for Windows 16.0 program. Data analysis was performed using percentage distributions, z test, and Spearman correlation analysis. Statistical significance was accepted p<0.05. While a positive correlation was detected between students' perceived breast cancer risk for themselves and perceived susceptibility, severity, benefit, self-efficacy related to BSE and health motivation mean scores, a negative and significant correlation was detected with perceived barriers to BSE mean score (p<0.05). Results showed that although female university students had some risk factors in terms of breast cancer, they have low levels of perceived risk factors for themselves.

Assessment of breast cancer risk perception, knowledge, and breast self-examination practices among market women in Owo, Ondo State, Nigeria

BackgroundBreast cancer (BC) is the leading cause of cancer death among women worldwide, and its incidence is increasing, particularly in low-medium-income countries (LMICs). Evidence shows that breast self-examination (BSE) is culturally acceptable, religiously friendly and inexpensive. This study assessed BC risk perception, knowledge and breast self-examination practices among market women in Ondo State, Nigeria.MethodsA descriptive cross-sectional survey was conducted among market women in 3 selected markets in Owo. A semi-structured interview-based questionnaire was used to collect data. The instrument consisted of five sections based on the objective of the study. Selection of the study participants was done using a multistage sampling technique. The test–retest method was used to determine the reliability of the instrument. Participants knowledge and practices were categorised into good (≥ 50% total score) and poor (< 50% total score) while risk perception was grouped into high (≥ 50% total score) and low (< 50% total score).Data were analysed using descriptive and inferential statistics at a p value < 0.05 for determining statistical significance.ResultsA total of 335 respondents completed the study and the mean age ± S.D. was 37.19 ± 9.19 years (range: 18–65 years). 47.5% of respondents were Christian while 60.0% of the respondents were married. 15.5% had tertiary education, and more than two-thirds were from the Yoruba tribe. More than two-thirds (78.5%) of the participants stated that they practiced breast self-examination, while 58.5% reported to have been taught how to perform BSE. 75.8% agreed that the use of injectable contraception or oral pills can result in BC, while 75.8% also agreed that women of reproductive age are at risk of BC. Less than 50% mentioned that they were uncomfortable taking off clothes in front of health professionals during the examination. The perceived risk of BC showed that 221 (65.97%), and 114 (34.03%) of respondents had high, and low levels of perceived risk of BC, respectively. However, 184 (54.93%) and 151 (45.07%) of the respondents had good and poor knowledge. The majority (139, 41.49%) of the respondents had poor BSE practice. Age (p = 0.023), educational qualifications (p < 0.001), average income per month (p < 0.001) and ethnicity (p = < 0.001) were statistically associated with knowledge of breast self-examination while religion (p = 0.02), marital status (p = 0.01), educational qualification (p = 0.001) and distance from facility (p = 0.009) were statistically associated with perceived risk of BC. Participants’ educational qualification (p = 0.006) and ethnicity (p = 0.013) were statistically associated with practice of BSE. Good knowledge was also identified as a significant predictor of good practice of participants among the women (95%CI: 4.574 (2.841–7.365), p < 0.001).ConclusionThis study identified high level of perception, good knowledge and good practice of BSE among majority of the market women in Owo Town. Interventions and extensive health education on BSE with the aim of creating positive awareness and understanding of BSE among the population should be encouraged.

Perceived Risk of Breast Cancer in Relation to Precautionary Behavior among Females in Saudi Arabia

Background: For the last two decades, the number of women with breast cancer in Saudi Arabia increased steadily. Risk perceptions or an individual&amp;#39;s perceived susceptibility to a threat are a key component of many health behavior change theories. Little is known about relationships between risk perceptions of breast cancer and performing preventive practices. &#x0D; &#x0D; This descriptive study highlights the risk perception of breast cancer in relation to preventive interventions among females over 18 years old in Riyadh, Saudi Arabia.&#x0D; &#x0D; Methods: Cross-sectional descriptive correlational design. An online questionnaire was conducted with 500 participants aged 18 years and older. The questionnaire was self-administrated electronic questionnaire designed by using Google Forms and it gated broadcast through social media channels such as WhatsApp and twitter. &#x0D; &#x0D; Results: The study emphasized a low risk perceptions about breast cancer and performing preventive practices. Positive correlation was found between female&amp;#39;s risk perceptions and doing the mammogram screening.&#x0D; &#x0D; Conclusions: Findings will be helpful to use risk perception of breast cancer in the prediction of women adopting preventive measures.

Risk perception and barriers to utilization of mammogram for breast cancer screening among female healthcare professionals in a tertiary health institution, Benin City, Nigeria

Abstract Background: For the effective functioning of health workers as promoters of breast cancer prevention through early detection, the need for relevant knowledge about the disease and its early detection is crucial. Objective: This study assessed the risk perceptions and barriers to use mammograms for breast cancer screening among female healthcare professionals in a tertiary health institution in Benin City, Nigeria. Materials and Methods: The quantitative approach was utilized in this study as it is a systematic process that helps to describe and test relationships among variables without bias. In line with this, a descriptive cross-sectional study was conducted with a sample of 255 female healthcare professionals from April 2023 to July 2023, using the multistage and convenience sampling method. A structured questionnaire was used to collect data with a reliability of 0.781. Data were analyzed using Statistical Package for Social Science (SPSS) version 22.0 and presented in words and frequency distribution tables. Hypotheses were tested with chi-square at a 5% level of significance. Results: A total of 225 nurses (88.2%) and 30 doctors (11.8%) participated in the study. The mean age was 45.69 ± 5.814 years (nurses = 45.55 ± 5.679 years; doctors 46.73 ± 6.757 years). Overall, 223 (87.5%) showed a positive risk perception of breast cancer with a mean of 2.74 ± 0.966. Only 35 (13.7%) respondents had a mammogram in the last 24 months before the study. Mean ± SD = 1.15 ±.376. Utilization was not associated with risk perception (P = 0.409), but there was a significant difference (P = 0.001) in the utilization of mammograms between nurses (10.7%) and doctors (36.7%). Perceived barriers to utilization of mammogram include cost 190 (86.4%), preference for other screening methods 210 (95.5%), fear of abnormal findings 189 (85.9%), and busy work schedule 200 (90.9%). Conclusion: There is a high positive risk perception of breast cancer but poor utilization of mammography. Therefore, it is recommended to sensitize female healthcare professionals on the need for mammography breast screening through training and re-training.

Awareness of alcohol as a breast cancer risk factor and intentions to reduce alcohol consumption among U.S. young adult women.

Alcohol consumption is prevalent in young adult women and linked with breast cancer risk. Research to inform interventions targeting alcohol consumption as a breast cancer prevention strategy is limited. We examined young women's awareness of alcohol use as a breast cancer risk factor, identified correlates of awareness, and determined how awareness and conceptual predictors relate to intentions to reduce drinking. Women aged 18-25 years who drank alcohol in the past month (N = 493) completed a cross-sectional survey. Measures captured sociodemographics, breast cancer risk factors, awareness of alcohol use as a breast cancer risk factor, intentions to reduce drinking, and conceptual predictors. Analyses examined correlates of awareness and associations between awareness, conceptual predictors, and intentions to reduce drinking. Awareness was low (28%) and intentions to reduce drinking were moderate (M = 2.60, SD = 0.73, range 1-4). In multivariable analyses, awareness was associated with greater worry about cancer, beliefs that there's not much one can do to reduce cancer risk and everything causes cancer, higher perceived breast cancer risk, and stronger beliefs that reducing drinking reduces breast cancer risk. Awareness was not associated with intentions to reduce drinking. Younger age, older age of alcohol initiation, negative attitudes towards alcohol, fewer friends consuming alcohol, and stronger self-efficacy were associated with intentions to reduce drinking. Few young women recognize alcohol consumption as a breast cancer risk factor. Researchers and policymakers can apply our findings to design new or refine existing interventions to optimize their impact on awareness and alcohol consumption in young women.

The role of polygenic risk scores in breast cancer risk perception and decision-making.

Polygenic risk scores (PRS) have the potential to improve the accuracy of clinical risk assessments, yet questions about their clinical validity and readiness for clinical implementation persist. Understanding how individuals integrate and act on the information provided by PRS is critical for their effective integration into routine clinical care, yet few studies have examined how individuals respond to the receipt of polygenic risk information. We conducted an embedded Ethical, Legal, and Social Implications (ELSI) study to examine if and how unaffected participants in a US population breast cancer screening trial understood and utilized PRS, as part of a multifactorial risk score combining traditional risk factors with a genetic risk assessment, to make screening and risk-reduction decisions. Semi-structured qualitative interviews were conducted with 24 trial participants who were designated at elevated risk for breast cancer due to their combined risk score. Interviews were analyzed using a grounded theory approach. Participants understood PRS conceptually and accepted it as one of many risk factors to consider, yet the value and meaning they ascribed to this risk estimate varied. Most participants reported financial and insurance barriers to enhanced screening with MRI and were not interested in taking risk-reducing medications. These findings contribute to our understanding of how PRS may be best translated from research to clinical care. Furthermore, they illuminate ethical concerns about identifying risk and making recommendations based on polygenic risk in a population screening context where many may have trouble accessing appropriate care.

Extending the sociology of candidacy: Bourdieu's relational social class and mid-life women's perceptions of alcohol-related breast cancer risk.

Alcohol is a modifiable breast cancer risk, increasing risk in a dose-dependent manner. Mid-life women (aged 45-64years) consume alcohol at higher rates than younger women and this, combined with age, make them a high-risk group for breast cancer. This critical public health problem has a seemingly obvious solution (reduce drinking); however, women do not necessarily know alcohol causes breast cancer, and if they do, reducing consumption is not always possible, or desirable. To innovate public health responses, we employ an interpretative sociological framework 'candidacy' to understand women's perspectives on breast cancer risk relative to alcohol consumption and their social class. Drawing on 50 interviews with Australian mid-life women, our findings reveal the socio-structural determinants of 'candidacy', that mean modifying alcohol consumption for breast cancer prevention is impacted by social class. Utilising Bourdieu's relational capitals, our interpretations show how social class shapes women's ascriptions and enactments of breast cancer candidacy. We offer an important theoretical extension to 'candidacy' by demonstrating more or less fluidity in women's assessment of breast cancer risk according to their agency to adopt breast cancer prevention messages. Understanding the social class possibilities and limitations in women's perceptions of breast cancer risk provides a new opportunity to reduce inequities in breast cancer incidence.

Abstract P6-05-39: Black Breast Cancer Survivors’ Sociocultural Perspectives of Beauty, and Use of Personal Care Products Containing Endocrine Disrupting Chemicals

Abstract The passage of H.R. 2116 (CROWN Act) prohibits hair texture and style discrimination based on race or national origin, thus, theoretically reducing structural barriers to economic mobility. Regardless, hair is synonymous with Black women’s identities. Possibly due to society’s afro-political ideologies of beauty, Black women tend to use more hair products compared to other racial groups. These standards include social structures that affect self-mediated worth, as well as structural and interpersonal racism based on appearance and societal status. The use of personal care products containing endocrine disrupting chemicals (EDCs) has been shown to increase Black women’s breast cancer risk. The Black identity, hair product use, and breast cancer scale (BHBS) was developed to measure the sociocultural constructs associated with Black women’s hair product use and perceived breast cancer risk. The purpose of this study was to validate the BHBS and examine hair product use among Black breast cancer survivors. Methods: Participants (N=162) completed a 27-item survey between 2020 and 2022 via a community-based participatory research project—Bench to Community Initiative. Principal component analyses (PCA) and confirmatory factor analysis (CFA) were used to establish the underlying component structures and determine the model fit. Chi-square tests were used to determine associations between BHBS subscales and product use, with a p-value &amp;lt; 0.05 defined as statistically significant. Products evaluated included washout and leave-in conditioners, salon, and do-it-yourself (DIY) relaxers, and salon and DIY hair dyes. Response options were used daily through several times a year (daily–yearly), used but stopped, and never used. Results: Participants were African American (90%) and African or Caribbean (10%) Black breast cancer survivors. The mean age (standard deviation [SD]) and stage of diagnosis (SD) was 37.4 ± 8.8 and 1.9 ± 0.97, respectively. PCA yielded two components that accounted for 63% of the total variance in the model. Five items measuring sociocultural perspectives about hair and identity (subscale 1 [S1]) accounted for 28% of the total variance (α = 0.73, 95% CI 0.71, 0.82). Six items assessing perceived breast cancer risk related to hair product use (subscale 2 [S2]) accounted for 35% of the total variance (α=0.86, 95% CI= 0.81, 0.94). CFA confirmed the two-component structure (Root Mean Square Error of Approximation = 0.034; Comparative Fit Index = 0.93; Tucker Lewis Index = 0.89). On average, participants used hair products daily–yearly, including conditioners (64%), relaxers (32%), and hair dyes (33%). The use of salon relaxers was significantly associated with BHBS subscales (S1and S2). Similarly, salon hair dye was significantly associated with S2 of the BHBS. Discussion: The BHBS is a valid measure of sociocultural perspectives associated with hair product use and perceived risk for Black breast cancer survivors. Given that hair remains an important cultural expression within the afro-political confines of identity, the health impacts of hair products containing EDCs used to craft these identities should be considered in intervention planning. Citation Format: Jared Bailey, Marissa Ericson, Tiah Tomlin-Harris, Dorothy Galloway, Lenna Dawkins-Moultin, Adana Llanos, Lindsey Treviño, Susanne B. Montgomery, Dede Teteh. Black Breast Cancer Survivors’ Sociocultural Perspectives of Beauty, and Use of Personal Care Products Containing Endocrine Disrupting Chemicals [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-39.

Poor health literacy associated with stronger perceived barriers to breast cancer screening and overestimated breast cancer risk.

Low health literacy (HL) is negatively associated with mammography screening uptake. However, evidence of the links between poor HL and low mammography screening participation is scarce. We conducted a cross-sectional questionnaire survey among participants of a cancer screening program. We measured HL using a validated Chinese instrument. We assessed breast cancer screening-related beliefs using the Health Belief Model and the accuracy of risk perception. We used multivariable regression models to estimate the relationship between HL and the outcomes. A total of 821 females were included. 264 (32.2%) had excellent or sufficient, 353 (43.0%) had problematic, and 204 (24.8%) had inadequate health literacy (IHL). Women with IHL were more likely to agree that high price (β = -0.211, 95% CI -0.354 to -0.069), lack of time (β = -0.219, 95% CI -0.351 to -0.088), inconvenient service time (β = -0.291, 95% CI -0.421 to -0.160), long waiting time (β = -0.305, 95% CI -0.447 to -0.164), fear of positive results (β = -0.200, 95% CI -0.342 to -0.058), embarrassment (β = -0.225, 95% CI -0.364 to -0.086), fear of pain (β = -0.154, 95% CI -0.298 to -0.010), fear of radiation (β = -0.177, 95% CI -0.298 to -0.056), lack of knowledge on service location (β = -0.475, 95% CI -0.615 to -0.335), and lack of knowledge on mammography (β = -0.360, 95% CI -0.492 to -0.228) were barriers. They were also less likely to have an accurate breast cancer risk perception (aOR 0.572, 95% CI 0.341 to 0.956). Women with lower HL could have stronger perceived barriers to BC screening and an over-estimation of their breast cancer risk. Tackling emotional and knowledge barriers, financial and logistical assistance, and guidance on risk perception are needed to increase their breast cancer screening uptake.

Understanding of Dense Breast and Perception of Breast Cancer Risk of Nurses with or without Dense Breast Notification

Understanding of Dense Breast and Perception of Breast Cancer Risk of Nurses with or without Dense Breast Notification

Abstract P001: Frequency and covariates of chemoprevention use among women at high risk for breast cancer

Abstract Purpose: To assess patterns of self-reported use of chemopreventive medications (i.e., tamoxifen, raloxifene) among women with elevated risk for breast cancer. Methods: Women with elevated breast cancer risk (N=134; n=98 BRCA1/2 mutation carriers, n=36 with ≥1.67% 5-year breast cancer per the National Cancer Institute [NCI] Breast Cancer Risk Assessment Tool [BCRAT; https://bcrisktool.cancer.gov/]) were recruited by advertising on social media and through community organizations. Between August 2020 and January 2021, participants completed an online survey assessing demographic characteristics (race, ethnicity, education, employment, income, insurance, and usual healthcare setting), psychosocial characteristics (perceived breast cancer risk, self-efficacy), provider recommendation for breast cancer chemoprevention, and prior/current use of breast cancer chemoprevention. Descriptive statistics characterized the frequency of provider recommendation for and use of breast cancer chemoprevention. Multivariable logistic regression analysis examined demographic and psychosocial characteristics associated with use of breast cancer chemoprevention. Results: Participants were in middle adulthood (M=45) and mostly non-Hispanic White (90%), with ≥ Bachelor’s degree (69%), household income ≥ $50,000/year (67%), and private health insurance (69%). Most were employed outside the home (73%) and typically received medical care at a private doctor’s office (81%). Most (76%) had discussed their breast cancer risk with a healthcare provider. About one-third (33%) reported receiving a provider recommendation for tamoxifen or raloxifene, 16% had previously taken one of these medications, and 10% were currently taking one of these medications. This included 24% of participants with a BRCA1/2 mutation and 35% of participants with a 5-year breast cancer risk ≥1.67%; use of chemoprevention did not differ between these groups (p=0.22). Compared to participants with private health insurance, those who were publicly insured were more likely to have taken chemoprevention medications (OR=8.27, p=0.04, 95% C.I.=1.95-35.11). No other demographic or psychosocial characteristics were associated with chemoprevention use (all p’s≥0.09). Conclusions: Consistent with prior research, few women with elevated breast cancer risk reported currently or previously taking chemopreventive medications. Despite little data on the efficacy of chemoprevention for BRCA1/2 mutation carriers, self-reported use of chemoprevention did not differ based on BRCA1/2 mutation status. Insurance status emerged as a key predictor of chemoprevention use, indicating that cost and insurance coverage may be a barrier for some women and may need to be addressed in interventions aiming to increase use of chemoprevention. Given the homogenous convenience sample, results might not extend to the broader population and need to be replicated in larger, more diverse samples. Citation Format: Claire C. Conley, Jennifer Rodriguez, Suzanne C. O’Neill, Susan T. Vadaparampil. Frequency and covariates of chemoprevention use among women at high risk for breast cancer. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P001.

Breast cancer worry, uncertainty, and perceived risk following breast density notification in a longitudinal mammography screening cohort

BackgroundDense breast notification (DBN) legislation aims to increase a woman’s awareness of her personal breast density and the implications of having dense breasts for breast cancer detection and risk. This information may adversely affect women’s breast cancer worry, perceptions of risk, and uncertainty about screening, which may persist over time or vary by sociodemographic factors. We examined short- and long-term psychological responses to DBN and awareness of breast density (BD).MethodsIn a predominantly Hispanic New York City screening cohort (63% Spanish-speaking), ages 40–60 years, we assessed breast cancer worry, perceived breast cancer risk, and uncertainties about breast cancer risk and screening choices, in short (1–3 months)- and long-term (9–18 months) surveys following the enrollment screening mammogram (between 2016 and 2018). We compared psychological responses by women’s dense breast status (as a proxy for DBN receipt) and BD awareness and examined multiplicative interaction by education, health literacy, nativity, and preferred interview language.ResultsIn multivariable models using short-term surveys, BD awareness was associated with increased perceived risk (odds ratio (OR) 2.27, 95% confidence interval (CI) 0.99, 5.20 for high, OR 2.19, 95% CI 1.34, 3.58 for moderate, vs. low risk) in the overall sample, and with increased uncertainty about risk (OR 1.97 per 1-unit increase, 95% CI 1.15, 3.39) and uncertainty about screening choices (OR 1.73 per 1-unit increase, 95% CI 1.01, 2.9) in Spanish-speaking women. DBN was associated with decreased perceived risk among women with at least some college education (OR 0.32, 95% CI 0.11, 0.89, for high, OR 0.50, 95% CI 0.29, 0.89, for moderate vs. low risk), while those with a high school education or less experienced an increase (OR 3.01, 95% CI 1.05, 8.67 high vs. low risk). There were no associations observed between DBN or BD awareness and short-term breast cancer worry, nor with any psychological outcomes at long-term surveys.ConclusionsAssociations of BD awareness and notification with breast cancer-related psychological outcomes were limited to short-term increases in perceived breast cancer risk dependent on educational attainment, and increases in uncertainty around breast cancer risk and screening choices among Spanish-speaking women.

Development of a web-based, theory-guided narrative intervention for women at elevated risk for breast cancer

ObjectiveTo describe the development of a web-based, theory-guided narrative intervention that replaces conventional pre-test genetic counseling for women at elevated breast cancer risk. MethodsWe used an iterative process that was guided by health behavior theory and feedback from multiple stakeholder groups including: 1) content input from genetic experts; 2) study team input; 3) review of video storyboards, video example, study logo, recruitment materials, post-test patient preference counseling survey, and additional study surveys; 4) video series development; and 5) intervention review and finalization of study-related materials. ResultsThe intervention is patient-centered providing convenience and an opportunity for an individual’s preferences for post-test counseling delivery. The intervention’s efficacy is being determined in a randomized controlled trial compared to conventional genetic counseling for adherence to recommended guidelines and changes in knowledge, perception of breast cancer risk, breast cancer-specific worry, and satisfaction with counseling. ConclusionIf efficacious, the intervention may improve the delivery of the genetic testing and counseling process, inform best practices, and reduce the genetic counseling workforce burden. Practice ImplicationsThe developed intervention has the potential to improve the genetic testing and counseling experience for women at elevated risk for breast cancer, inform best practices, and reduce genetic counseling workforce burden.

Operating on Anxiety: Negative Affect toward Breast Cancer and Choosing Contralateral Prophylactic Mastectomy.

Rates of contralateral prophylactic mastectomy (CPM)-removal of the healthy breast following breast cancer diagnosis-have increased, particularly among women for whom CPM provides no survival benefit. Affective (i.e., emotional) decision making is often blamed for this increase. We studied whether greater negative breast cancer affect could motivate uptake of CPM through increased cancer risk perceptions and biased treatment evaluations. We randomly assigned healthy women with average breast-cancer risk (N = 1030; Mage = 44.14, SD = 9.23 y) to 1 of 3 affect conditions (negative v. neutral v. positive narrative manipulation) in a hypothetical online experiment in which they were asked to imagine being diagnosed with cancer in one breast. We assessed 1) treatment choice, 2) affect toward CPM, and 3) perceived risk of future breast cancer in each breast (cancer affected and healthy) following lumpectomy, single mastectomy, and CPM. The manipulation caused women in the negative and neutral narrative conditions (26.9% and 26.4%, respectively) to choose CPM more compared with the positive narrative condition (19.1%). Across conditions, women's CPM affect did not differ. However, exploratory analyses addressing a possible association of affect toward cancer-related targets suggested that women in the negative narrative condition may have felt more positively toward CPM than women in the positive narrative condition. The manipulation did not have significant effects on breast cancer risk perceptions. The manipulation of affect had a small effect size, possibly due to the hypothetical nature of this study and/or strong a priori knowledge and attitudes about breast cancer and its treatment options. Increased negative affect toward breast cancer increased choice of CPM over other surgical options and might have motivated more positive affective evaluations of CPM. This study used narratives to elicit different levels of negative integral affect toward breast cancer to investigate the effects of affect on breast cancer treatment choices.Increased negative affect toward breast cancer increased the choice of double mastectomy over lumpectomy and single mastectomy to treat a hypothetical, early-stage cancer.The narrative manipulation of negative affect toward breast cancer did not change the perceived risks of future cancer following any of the surgical interventions.Negative affect toward breast cancer may have biased affective evaluations of double mastectomy.