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The common sense model posits that individuals' understanding of illness is based upon somatic symptoms and life experiences and thus may differ significantly from the biomedical view of illness. The current study used the common sense model to understand cancer risk perceptions in 99 individuals testing for BRCA1/2 mutations. Specifically, we examined change from post-counseling to post-result in (1) absolute risk (risk of developing cancer in one's lifetime) and (2) comparative risk (risk relative to the general population). Results indicated that absolute risk showed a trend such that those with a personal history of cancer receiving uninformative negative results reported decreased absolute risk. Further, individuals receiving uninformative negative results reported decreased comparative risk. Those with no personal cancer history receiving informative negative results did not decrease in risk over time nor did their risk differ from those with a personal cancer history, evidencing unrealistic pessimism regarding their risk of cancer. The reasons provided for individuals' risk perceptions could be classified in terms of attributes of the common sense model and included the: (1) causes of cancer (e.g. family history, mutation status); (2) control or cure of cancer through health behaviors and/or surgery; and (3) perceived timeline for developing cancer (e.g. time left in life to develop cancer). We conclude that key to developing interventions to improve understanding of cancer risk and promoting effective cancer control mechanisms is an understanding of the specific reasons underlying individuals' perceptions of cancer risk.

Background: Genetic counseling for BRCA1 and BRCA2 mutations (mutations associated with increased risk of breast-ovarian cancer) endeavors to communicate information that will help individuals make informed decisions IntroductionGenetic counseling for hereditary breast-ovarian cancer associated with BRCA1/2 mutations represents a specific area for the communication of complex cancer genetic information to assist individuals in making informed decisions about genetic testing. Our study focused on knowledge of and beliefs about breast-ovarian cancer genetics from before to after counseling on specific topics: personal behavior, mechanisms of cancer inheritance, meaning of a positive result, practitioner knowledge, frequency of inherited cancer, and meaning of a negative result. These topic areas have been identified as key to genetic counseling for hereditary breast-ovarian cancer. We located no studies that reported changes in knowledge in key topic areas from before to after counseling and the receipt of results in the Ashkenazi Jewish population at increased risk for having a mutation. Therefore, the goals of this paper are to examine the knowledge of and beliefs about cancer genetics both before and after counseling and the relationship of knowledge and beliefs to receipt of results in the Ashkenazi Jewish population at increased risk for carrying BRCA1/2 mutations. Risks Associated With BRCA1/2 MutationsWomen carrying mutations in BRCA1/2 have up to an 85% risk of breast cancer and up to a 60% risk of ovarian cancer by age 70. 1,2 For men with the BRCA2 gene mutation, the risk of breast cancer is also increased above population rates. 3 In the Ashkenazi Jewish population, the frequency of three BRCA1 and BRCA2 mutations (the Ashkenazi Jewish panel) is approximately 2.6%, 4 while the general population frequency is approximately 0.1%. 5 The presence of risk factors, such as a personal and/or family history of breast or ovarian cancer and multiple generations affected, increases the risk of having a mutation. 2,6 Hence, these mutations occur at a higher frequency in the Ashkenazi Jewish population than in the general population and represent a significant health threat due to their association with cancer.