More than 90% of women undergoing mammography screening could not give an accurate estimate of their personal risk of developing breast cancer, according to results of a large survey reported at the 2013 ASCO Breast Cancer Symposium and featured in a premeeting presscast. The survey showed that a similar percentage of women overestimated and underestimated their actual risk. Forty percent of respondents also said they had never discussed their personal risk with a health-care provider.
Objectives and Implications
“These findings suggest that the pink ribbons, marches, large public health awareness campaigns about breast cancer, and other educational messages aren’t working. It is disconcerting that only 9.4% of respondents could tell us what their risk actually was. We need to encourage health-care providers to have this discussion with their patients, and patients need to be educated differently,” said lead study author Jonathan Herman, MD, an obstetrician and gynecologist at Hofstra North Shore-LIJ Medical School in New Hyde Park, New York.
Part of the study’s objective was to determine perceptions of risk among different ethnicities, and responses showed a low level of knowledge across the board for all ethnicities. The level of understanding could be even lower in the general population not concerned enough about breast cancer risk to participate in mammography screening, Dr. Herman noted.
If women are not aware of their actual risk of developing breast cancer, they will not make appropriate decisions about interventions, he continued. “Understanding your risk level is an important precursor of care. Women at high risk—if they know their risk—can avail themselves of early detection modalities and chemopreventive medications,” Dr. Herman said. “Accurate understanding will lead to a tailored plan according to risk and, thus, to better outcomes.”
Approximately 15,000 surveys were given to women aged 35 to 70 years who were having a mammogram at 1 of 21 centers on Long Island, NY. The 25 survey questions were adapted from the National Cancer Institute’s Breast Cancer Risk Assessment Tool that estimates risk of developing invasive breast cancer; the questions covered demographics, breast cancer risk factors, including personal and family history of breast cancer, and any prior breast cancer risk assessments and discussions. The study sample was based on 9,873 respondents.
The researchers calculated the actual lifetime risk of developing breast cancer for each of the 9,873 respondents and compared that with each woman’s personal estimate; a difference of greater than 10% from the calculated value was deemed inaccurate.
Only 707 women (9.4%) correctly estimated their risk; 3,359 women (44.7%) underestimated their risk, and 3,454 (45.9%) overestimated it. Of the women who participated, 2,131 estimated they had a 0% to 1% lifetime risk of breast cancer, 2,581 estimated that they had less than a 50% risk, and 223 estimated that they had more than a 90% risk.
Analyzing results according to ethnicity, Caucasian women were more likely to overestimate their risk (38.6%) than African Americans (33.7%) or Asians (31%). Minority groups were more likely than Caucasians to underestimate their risk, with underestimation rates as follows: Caucasians (38.6%), African Americans (57.6%), Asians (58.8%), and Hispanics (50.4%).
During the question-and-answer session. Dr. Herman said that a family history of breast cancer deserves as much attention as a history of cardiovascular disease. Family history should be part of the questionnaire when a new patient comes into a practice, he said. ■
Disclosure: Dr. Herman reported no potential conflicts of interest.
1. Herman JD, Herman SM: Women’s understanding of personal breast cancer history. Does ethnicity matter? 2013 Breast Cancer Symposium. Abstract 4. Presented September 7, 2103.