Risk estimation, anxiety, and breast cancer worry in women at risk for breast cancer: A single‐arm trial of personalized risk communication

Abstract

Objective Elevated anxiety and breast cancer worry can impede mammographic screening and early breast cancer detection. Genetic advances and risk models make personalized breast cancer risk assessment and communication feasible, but it is unknown whether such communication of risk affects anxiety and disease‐specific worry. We studied the effect of a personalized breast cancer screening intervention on risk perception, anxiety, and breast cancer worry. Methods Women with a normal mammogram but elevated risk for breast cancer (N = 122) enrolled in the Athena Breast Health risk communication program were surveyed before and after receiving a letter conveying their breast cancer risk and a breast health genetic counselor consultation. We compared breast cancer risk estimation, anxiety, and breast cancer worry before and after risk communication and evaluated the relationship of anxiety and breast cancer worry to risk estimation accuracy. Results Women substantially overestimated their lifetime breast cancer risk, and risk communication somewhat mitigated this overestimation (49% pre‐intervention, 42% post‐intervention, 13% Gail model risk estimate, P < .001). Both general anxiety and breast cancer worry declined significantly after risk communication in women with high baseline anxiety. Baseline anxiety and breast cancer worry were essentially unrelated to risk estimation accuracy, but risk communication increased alignment of worry with accuracy of risk assessment. Conclusions Personalized communication about breast cancer risk was associated with modestly improved risk estimation accuracy in women with relatively low anxiety and less anxiety and breast cancer worry in women with higher anxiety. We detected no negative consequences of informing women about elevated breast cancer risk.

The accuracy of breast cancer risk self-assessment does not correlate with knowledge about breast cancer and knowledge and attitudes towards primary chemoprevention

“…Women who underestimate their personal BC risk are less likely to participate in screening programs and other primary prevention strategies ( Park et al, 2009 , Katapodi et al, 2010 ). On the contrary, the overestimation of BC risk results in unnecessary diagnostic procedures, needless interventions and anxiety ( Xie et al, 2019 , Speiser et al, 2019 , de Jonge et al, 2009 , Davids et al, 2004 , Alexander et al, 1996 ). Accurate calculation and perception of personal BC risk are a critical part of primary and secondary BC prevention ( de Jonge et al, 2009 , Abittan et al, 2019 , Metcalfe and Narod, 2002 ).…”

Multilevel Factors Impacting Mammography Screening Decisions in the Elderly: A Clinician and Patient Pilot

“…Women often overestimate their breast cancer risk 15,16,35−37 and this led to anxiety and disease-speci c worry. 15 In response, family and friends can push women to continue screening past the point where patient would have stopped. 33 Further, women in our study held fairly strong intentions to talk to their primary clinician about stopping mammography.…”

Assessing the clinical utility of genetic risk scores for targeted cancer screening

“…Questionnaires were sent to participants in the format of their choosing: via email using REDCap software, or via postal mail. The questionnaires used were similar to those previously used to collect data on worry about cancer risk and diagnosis, including the US Health Information National Trends Survey (US HINTS), Lerman's Cancer Worry Scale and the Cancer Worry Scale for Genetic Counseling [12][13][14][15][16][17][18]. Cancer screening-related health information was also collected throughout the follow up period of 18-42 months (data not reported).…”