Missed Opportunities: Family History and Behavioral Risk Factors in Breast Cancer Risk Assessment Among a Multiethnic Group of Women
- 126 Downloads
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 wordsfamily 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
- 6.Korde LA, Calzone KA, Zujewski J. Assessing breast cancer risk: genetic factors are not the whole story. Postgrad Med. 2004;116(4):6–8, 11–4, 19–20.Google Scholar
- 25.San Francisco Mammography Registry. In. San Franicsco; 2006.Google Scholar
- 28.AHRQ. Screening for Breast Cancer. In: U.S. Preventive Services Task Force; 2002.Google Scholar
- 31.Likert RA. A technique for the measurement of attitudes. Arch Psychol. 1932;140.Google Scholar
- 32.Nunnally JC. Measurement of Sentiments. In: Psychometric Theory: McGraw-Hill; 1978:602–7.Google Scholar
- 33.StataCorp. Stata’s User Guide Version 9. College Station, Texas: Stata Press; 2005.Google Scholar
- 36.Bernstein AB, Hing E, Moss Aj, Allen KF, Siller AB, RB T. Health care in America: Trends in utilization. In: National Center for Health Statistics; 2003.Google Scholar
- 38.CDC. Family History Public Health Initiative. In: Center for Disease Control and Prevention, Office of Genomics and Disease Prevention.Google Scholar