Breast Cancer Research and Treatment

, Volume 161, Issue 3, pp 557–565 | Cite as

Recurrence risk perception and quality of life following treatment of breast cancer

  • Sarah T. HawleyEmail author
  • Nancy K. Janz
  • Kent A. Griffith
  • Reshma Jagsi
  • Christopher R. Friese
  • Allison W. Kurian
  • Ann S. Hamilton
  • Kevin C. Ward
  • Monica Morrow
  • Lauren P. Wallner
  • Steven J. Katz



Little is known about different ways of assessing risk of distant recurrence following cancer treatment (e.g., numeric or descriptive). We sought to evaluate the association between overestimation of risk of distant recurrence of breast cancer and key patient-reported outcomes, including quality of life and worry.


We surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer identified through SEER registries of Los Angeles County & Georgia (2013–14) ~2 months after surgery (N = 2578, RR = 71%). Actual 10-year risk of distant recurrence after treatment was based on clinical factors for women with DCIS & low-risk invasive cancer (Stg 1A, ER+, HER2−, Gr 1–2). Women reported perceptions of their risk numerically (0–100%), with values ≥10% for DCIS & ≥20% for invasive considered overestimates. Perceptions of “moderate, high or very high” risk were considered descriptive overestimates. In our analytic sample (N = 927), we assessed factors correlated with both types of overestimation and report multivariable associations between overestimation and QoL (PROMIS physical & mental health) and frequent worry.


30.4% of women substantially overestimated their risk of distant recurrence numerically and 14.7% descriptively. Few factors other than family history were significantly associated with either type of overestimation. Both types of overestimation were significantly associated with frequent worry, and lower QoL.


Ensuring understanding of systemic recurrence risk, particularly among patients with favorable prognosis, is important. Better risk communication by clinicians may translate to better risk comprehension among patients and to improvements in QoL.


Breast cancer Risk Perception Quality of life 



This work 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 103 885; 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. We acknowledge the outstanding 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., Rachel Tocco, M.A., 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.

Compliance with ethical standards

Conflict of interest

Dr. Kurian has received research funding for work performed outside of the present study from Myriad Genetics, Invitae, Ambry Genetics, GeneDx, and Genomic Health. All the other authors have no conflict to disclose.

Ethical standards

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 (outside the USA) 2016

Authors and Affiliations

  • Sarah T. Hawley
    • 1
    • 2
    • 3
    Email author
  • Nancy K. Janz
    • 4
  • Kent A. Griffith
    • 5
  • Reshma Jagsi
    • 6
  • Christopher R. Friese
    • 7
  • Allison W. Kurian
    • 8
  • Ann S. Hamilton
    • 9
  • Kevin C. Ward
    • 10
  • Monica Morrow
    • 11
  • Lauren P. Wallner
    • 1
    • 12
  • Steven J. Katz
    • 1
    • 2
  1. 1.Division of General Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  2. 2.Department of Health Management and PolicyUniversity of MichiganAnn ArborUSA
  3. 3.Ann Arbor VA Center for Clinical Management Research, Ann Arbor VA Health Care SystemUniversity of MichiganAnn ArborUSA
  4. 4.Department of Health Behavior and Health EducationUniversity of MichiganAnn ArborUSA
  5. 5.Center for Cancer Biostatistics, School of Public HealthUniversity of MichiganAnn ArborUSA
  6. 6.Department of Radiation OncologyUniversity of MichiganAnn ArborUSA
  7. 7.Department of Systems, Populations, and Leadership, School of NursingUniversity of MichiganAnn ArborUSA
  8. 8.Departments of Medicine and Health Research and PolicyStanford UniversityStanfordUSA
  9. 9.Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  10. 10.Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaUSA
  11. 11.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  12. 12.Department of EpidemiologyUniversity of MichiganAnn ArborUSA

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