Sociocultural Predictors of Breast Cancer Risk Perceptions in African American Breast Cancer Survivors

Abstract

Although African American breast cancer survivors are at increased risk for developing breast cancer again, empirical data are not available on breast cancer risk perceptions in these women. This study characterized perceived risk of developing breast cancer in African American breast cancer survivors at risk for having a BRCA1 or BRCA1 (BRCA1/2) mutation and identified factors having significant independent associations with risk perceptions. Participants were 95 African American breast cancer survivors at an increased risk for having a BRCA1/2 mutation. Risk perceptions and sociodemographic, clinical, treatment, and sociocultural factors were collected during a structured telephone interview. Most women reported that they had the same or lower risk of developing breast cancer again compared with other women (53%); however, a substantial minority of women (47%) reported that they had a higher or much higher risk. Factors having significant independent associations with heightened risk perceptions included having a z10% prior probability of having a BRCA1/2 mutation [odds ratio (OR), 2.91; 95% confidence interval (95% CI), 1.09-7.72; P = 0.03] and more years of formal education (OR, 2.74; 95% CI, 1.02-7.36; P = 0.05). In addition, women who thought about the past a lot were three times more likely to report heightened risk perceptions compared with those who did not think about the past a lot (OR, 3.72; 95% CI, 1.45-9.57; P = 0.01). These results suggest that it may be important to ensure adequate risk comprehension among African American women as part of genetic counseling for inherited breast-ovarian cancer risk. Discussion of risk perceptions within the context of existing beliefs and values may facilitate this process. (Cancer Epidemiol Biomarkers Prev 2007;16(2):244 -8)

Effect of Genetic Counseling and Testing for <i>BRCA1</i> and <i>BRCA2</i> Mutations in African American Women: A Randomized Trial

“…While reduction in cancer worry is clearly a benefit of genetic testing, it is important to consider whether reduction in perceived risk following genetic counseling is beneficial to African American women, especially in light of previous research which has shown that African American women with a personal and/or family history of breast cancer may not recognize that they have an increased risk of developing disease [22,][32]. Greater perceived risk has been positively associated with utilization of cancer screening and risk reduction options among women in the general population [16] and those from hereditary cancer families [17], respectively.…”

“…CTGC differed from SGC in that cultural beliefs and values related to health care decision-making were addressed. Consistent with guidelines for culturally competent genetic counseling [18,19], the CTGC protocol incorporated discussion of beliefs and values related to spirituality and religion, temporal orientation, and communalism, which have been associated with decisions about genetic testing, medical care, and risk perceptions among African American women [20,21,22]. Specifically, a genogram and structured probes were used in the CTGC protocol to encourage women to discuss how these beliefs and values would be used to make decisions about genetic testing and cope with testing outcomes.…”

“…We used a validated Likert style item to evaluate breast cancer risk perceptions [22,24]. Specifically, women were asked what their chances of getting breast cancer were compared to other women their age (1 = much lower to 5 = much higher).…”

A Pilot Study of Hereditary Breast and Ovarian Knowledge Among a Multiethnic Group of Hispanic Women with a Personal or Family History of Cancer

“…While this issue has not been specifically examined among Hispanic women, previous studies suggest that women may not regard personal cancer history as a risk factor for HBOC. In a study of 95 African American breast cancer survivors at increased risk for HBOC, most women reported that they had the same or lower risk of developing breast cancer again compared with other women (53%) (Brewster et al, 2007). In a qualitative study of patients recently diagnosed with breast cancer referred for genetic counseling and testing, several women questioned why they received the referral given the lack of a family history of breast cancer (Vadaparampil et al, 2009).…”

Cultural and Environmental Factors of Triple-Negative Breast Carcinomas

“…There is a body of research that has explored inherited genetic proclivity towards the triple-negative phenotype, which indicates a role of BRCA1 and BRCA2 gene mutations in African American women [4,9,[16][17][18]. However, it is clear that risk is not entirely genetic and this review seeks to elucidate non-inherited risk factors (which are therefore modifiable) and will not discuss genetic proclivity in depth.…”