Accuracy of self-perceived risk perception of breast cancer development in Iranian women

Abstract

Backgrand: The accuracy of subjective risk perception is a matter of concern in breast cancer development. The objective of this study was to evaluate the accuracy of self-perceived risk assessment compared to actual risk. Methods: The demographic, clinical, and reproductive characteristics of 800 women aged 35-85 years were collected with an in-person interview. The self-perceived risk was assessed using the visual analog scale (VAS) and the actual risk was calculated from the Gail model. Gail’s cutoff of 1.66% risk was used to categorize the estimated 5-year actual risk as low/average risk (<1.66%) and high risk (≥1.66). In low/average risk, if the self-perceived risk> actual risk, then individuals were categorized as overestimating. Similarly, in high-risk women, if the perceived risk<actual risk, then, the subjects were labeled as under-estimate; otherwise, it was labeled as accurate. The Kappa statistics were used to determine the agreement between self-perceived risk and actual risk. ROC analysis was applied to determine the accuracy of self-perceived risk in the prediction of actual risk. Results: The perceived risk was significantly higher than actual risk (p=0.001, 0.01 for 5-year and lifetime risk respectively). Both in low and high-risk groups about half of the women over-estimate and underestimate the risk by subjective risk perception. For a 5-year risk assessment, there was no agreement at all between perceived risk and actual risk (Kappa=0.00, p=0.98) but a very low agreement between them in lifetime risk assessment (Kappa=0.09, p=0.005). The performance of accuracy of risk perception versus actual risk was very low (AUC=0.53, 95%CI: 0.44-0.61 and AUC=0.58, 95%CI: 0.54-0.62 for the 5- year risk and lifetime risk respectively). Conclusion: The clinical performance of risk perception based on VAS is very poor. Thus, the efforts of the public health education program should focus on the correct perception of breast cancer risk among Iranian women.