Journal of General Internal Medicine

, Volume 22, Issue 3, pp 308–314 | Cite as

Missed Opportunities: Family History and Behavioral Risk Factors in Breast Cancer Risk Assessment Among a Multiethnic Group of Women

  • Leah S. Karliner
  • Anna Napoles-Springer
  • Karla Kerlikowske
  • Jennifer S. Haas
  • Steven E. Gregorich
  • Celia Patricia KaplanEmail author
Original Article


Clinician’s knowledge of a woman’s cancer family history (CFH) and counseling about health-related behaviors (HRB) is necessary for appropriate breast cancer care.


To evaluate whether clinicians solicit CFH and counsel women on HRB; to assess relationship of well visits and patient risk perception or worry with clinician’s behavior.


Cross-sectional population-based telephone survey.


Multiethnic sample; 1,700 women from San Francisco Mammography Registry with a screening mammogram in 2001–2002.


Predictors: well visit in prior year, self-perception of 10-year breast cancer risk, worry scale. Outcomes: Patient report of clinician asking about CFH in prior year, or ever counseling about HRB in relation to breast cancer risk. Multivariate models included age, ethnicity, education, language of interview, insurance/mammography facility, well visit, ever having a breast biopsy/follow-up mammography, Gail-Model risk, Jewish heritage, and body mass index.


58% reported clinicians asked about CFH; 33% reported clinicians ever discussed HRB. In multivariate analysis, regardless of actual risk, perceived risk, or level of worry, having had a well visit in prior year was associated with increased odds (OR = 2.3; 95% CI 1.6, 3.3) that a clinician asked about CFH. Regardless of actual risk of breast cancer, a higher level of worry (OR = 1.9; 95% CI 1.4, 2.6) was associated with increased odds that a clinician ever discussed HRB.


Clinicians are missing opportunities to elicit family cancer histories and counsel about health-related behaviors and breast cancer risk. Preventive health visits offer opportunities for clinicians to address family history, risk behaviors, and patients’ worries about breast cancer.

Key words

family history breast cancer risk assessment multiethnic 



This research was conducted with the support of the California Breast Cancer Research Program (grant number 6PB-0053) and the NCI-funded Breast Cancer Surveillance Consortium Cooperative Agreement (U01CA63740).

Potential Financial Conflicts of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Leah S. Karliner
    • 1
  • Anna Napoles-Springer
    • 1
    • 2
  • Karla Kerlikowske
    • 3
    • 4
    • 5
  • Jennifer S. Haas
    • 6
  • Steven E. Gregorich
    • 1
  • Celia Patricia Kaplan
    • 1
    • 2
    Email author
  1. 1.Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse PopulationsUniversity of CaliforniaSan FranciscoUSA
  2. 2.UCSF Comprehensive Cancer CenterUniversity of CaliforniaSan FranciscoUSA
  3. 3.General Internal Medicine Section, Department of Veterans’ AffairsUniversity of CaliforniaSan FranciscoUSA
  4. 4.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA
  5. 5.Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  6. 6.Division of General Medicine and Primary Care, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA

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