Breast Cancer Research and Treatment

, Volume 161, Issue 3, pp 525–535 | Cite as

The impact of doctor–patient communication on patients’ perceptions of their risk of breast cancer recurrence

  • Nancy K. JanzEmail author
  • Yun Li
  • Brian J. Zikmund-Fisher
  • Reshma Jagsi
  • Allison W. Kurian
  • Lawrence C. An
  • M. Chandler McLeod
  • Kamaria L. Lee
  • Steven J. Katz
  • Sarah T. Hawley



Doctor–patient communication is the primary way for women diagnosed with breast cancer to learn about their risk of distant recurrence. Yet little is known about how doctors approach these discussions.


A weighted random sample of newly diagnosed early-stage breast cancer patients identified through SEER registries of Los Angeles and Georgia (2013–2015) was sent surveys about ~2 months after surgery (Phase 2, N = 3930, RR 68%). We assessed patient perceptions of doctor communication of risk of recurrence (i.e., amount, approach, inquiry about worry). Clinically determined 10-year risk of distant recurrence was established for low and intermediate invasive cancer patients. Women’s perceived risk of distant recurrence (0–100%) was categorized into subgroups: overestimation, reasonably accurate, and zero risk. Understanding of risk and patient factors (e.g. health literacy, numeracy, and anxiety/worry) on physician communication outcomes was evaluated in multivariable regression models (analytic sample for substudy = 1295).


About 33% of women reported that doctors discussed risk of recurrence as “quite a bit” or “a lot,” while 14% said “not at all.” Over half of women reported that doctors used words and numbers to describe risk, while 24% used only words. Overestimators (OR .50, CI 0.31–0.81) or those who perceived zero risk (OR .46, CI 0.29–0.72) more often said that their doctor did not discuss risk. Patients with low numeracy reported less discussion. Over 60% reported that their doctor almost never inquired about worry.


Effective doctor–patient communication is critical to patient understanding of risk of recurrence. Efforts to enhance physicians’ ability to engage in individualized communication around risk are needed.


Breast cancer Physician communication Risk perception Worry about recurrence 



We acknowledge the work of our project staff (Mackenzie Crawford, M.P.H. and Kiyana Perrino, M.P.H. from the Georgia Cancer Registry; Jennifer Zelaya, Pamela Lee, Maria Gaeta, Virginia Parker, B.A. and Renee Bickerstaff-Magee from USC; Rebecca Morrison, M.P.H., Alexandra Jeanpierre, M.P.H., Stefanie Goodell, B.S., and Rose Juhasz, Ph.D. from the University of Michigan). We acknowledge with gratitude the breast cancer patients who responded to our survey.


This study was funded by Grant P01 CA163233 to the University of Michigan from the National Cancer Institute. The collection of Los Angeles County cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP003862-04/DP003862; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the CDC or their contractors and subcontractors is not intended nor should be inferred. The collection of cancer incidence data in Georgia was supported by contract HHSN261201300015I, Task Order HHSN26100006 from the NCI and cooperative agreement 5NU58DP003875-04-00 from the CDC. The ideas and opinions expressed herein are those of the author(s) and endorsement by the States of California and Georgia, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred.

Compliance with ethical standards

Conflicts of interest

Allison Kurian has received research funding for work performed outside of the current study from MyriadGenetics, Invitae, Ambry Genetics, GenDx, and Genomic Health. No other authors have conflicts of interests to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study through their return of a completed survey.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Nancy K. Janz
    • 1
    Email author
  • Yun Li
    • 2
  • Brian J. Zikmund-Fisher
    • 1
    • 3
    • 4
  • Reshma Jagsi
    • 5
  • Allison W. Kurian
    • 6
  • Lawrence C. An
    • 7
  • M. Chandler McLeod
    • 2
  • Kamaria L. Lee
    • 3
  • Steven J. Katz
    • 3
    • 8
  • Sarah T. Hawley
    • 3
    • 8
    • 9
  1. 1.Department of Health Behavior and Health Education, School of Public HealthUniversity of MichiganAnn ArborUSA
  2. 2.Department of BiostatisticsUniversity of MichiganAnn ArborUSA
  3. 3.Division of General Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  4. 4.Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborUSA
  5. 5.Department of Radiation OncologyUniversity of MichiganAnn ArborUSA
  6. 6.Departments of Medicine and Health Research and PolicyStanford UniversityStanfordUSA
  7. 7.Center for Health Communications Research, Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  8. 8.Department of Health Management and PolicyUniversity of MichiganAnn ArborUSA
  9. 9.Veterans Administration Center for Clinical Management ResearchAnn Arbor VA Health Care SystemAnn ArborUSA

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