Journal of General Internal Medicine

, Volume 20, Issue 4, pp 360–365 | Cite as

Impact of the cancer risk intake system on patient-clinician discussions of tamoxifen, genetic counseling, and colonoscopy

  • Celette Sugg SkinnerEmail author
  • Susan M. Rawl
  • Barry K. Moser
  • Adam H. Buchanan
  • Linda L. Scott
  • Victoria L. Champion
  • Joellen M. Schildkraut
  • Giovanni Parmigiani
  • Shelly Clark
  • David F. Lobach
  • Lori A. Bastian
Innovations In Education And Clinical Practice


The Cancer Risk Intake System (CRIS), a computerized program that “matches” objective cancer risks to appropriate risk management recommendations, was designed to facilitate patient-clinician discussion. We evaluated CRIS in primary care settings via a single-group, self-report, pretest-posttest design. Participants completed baseline telephone surveys, used CRIS during clinic visits, and completed followup surveys 1 to 2 months postvisit. Compared with proportions reporting having had discussions at baseline, significantly greater proportions of participants reported having discussed tamoxifen, genetic counseling, and colonoscopy, as appropriate, after using CRIS. Most (79%) reported CRIS had “caused” their discussion. CRIS is an easily used, disseminable program that showed promising results in primary care settings.


Cancer Risk Tamoxifen Breast Cancer Risk Natl Cancer Inst Colorectal Cancer Screening 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Myles J, Duffy S, Nixon R, et al. Initial results of a study into the effectiveness of breast cancer screening in a population identified to be at high risk. Revue de Epidemiologie et de Sante Publique. 2001;49:471–5.Google Scholar
  2. 2.
    Tilanus-Linthorst MM, Bartels CC, Obdeijn AI, Oudkerk M. Earlier detection of breast cancer by surveillance of women at familial risk. Eur J Cancer. 2000;36:514–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Burt RW. Colon cancer screening. Gastroenterology. 2000;119:837–53.PubMedCrossRefGoogle Scholar
  4. 4.
    Lieberman D. Screening/early detection model for colorectal cancer. Why screen? Cancer. 1994;74:2023–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Brekelmans CT, Seynaeve C, Bartels CC, et al. Effectiveness of breast cancer surveillance in BRCA1/2 gene mutation carriers and women with high familial risk. J Clin Oncol. 2001;19:924–30.PubMedGoogle Scholar
  6. 6.
    Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology. 2003;124:544–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Smith RA, Cokkinides V, Eyre HJ, American Cancer Society. American Cancer Society guidelines for the early detection of cancer, 2003. CA Cancer J Clin. 2003;53:27–43.PubMedCrossRefGoogle Scholar
  8. 8.
    Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371–88.PubMedCrossRefGoogle Scholar
  9. 9.
    Kinsinger LS, Harris R, Woolf SH, Sox HC, Lohr KN. Chemoprevention of breast cancer: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137:59–69.PubMedGoogle Scholar
  10. 10.
    Freedman AN, Graubard BI, Rao SR, McCaskill-Stevens W, Ballard-Barbash R, Gail MH. Estimates of the number of US women who could benefit from tamoxifen for breast cancer chemoprevention. J Natl Cancer Inst. 2003;95:526–32.PubMedCrossRefGoogle Scholar
  11. 11.
    Pichert G, Bolliger B, Buser K, Pagani O. Swiss Institute for Applied Cancer Research Network for Cancer Predisposition Testing and Counseling. Evidence-based management options for women at increased breast/ovarian cancer risk. Ann Oncol. 2003;14:9–19.PubMedCrossRefGoogle Scholar
  12. 12.
    Gail MH, Costantino JP, Bryant J, et al. Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer. J Natl Cancer Inst. 1999;91:1829–46.PubMedCrossRefGoogle Scholar
  13. 13.
    Biesecker BB, Boehnke M, Calzone K, et al. Genetic counseling for families with inherited susceptibility to breast and ovarian cancer. JAMA. 1993;269:1970–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Morris KT, Johnson N, Krasikov N, Allen M, Dorsey P. Genetic counseling impacts decision for prophylactic surgery for patients perceived to be at high risk for breast cancer. Am J Surg. 2001;181:431–3.PubMedCrossRefGoogle Scholar
  15. 15.
    Meiser B, Butow PN, Barratt AL, et al. Long-term outcomes of genetic counseling in women at increased risk of developing hereditary breast cancer. Patient Educ Couns. 2001;44:215–25.PubMedCrossRefGoogle Scholar
  16. 16.
    Meiser B, Halliday JL. What is the impact of genetic counselling in women at increased risk of developing hereditary breast cancer? A meta-analytic review. Soc Sci Med. 2002;54:1463–70.PubMedCrossRefGoogle Scholar
  17. 17.
    American Society of Clinical Oncology. American Society of Clinical Oncology policy statement update: genetic testing for cancer susceptibility. J Clin Oncol. 2003;21:2397–406.CrossRefGoogle Scholar
  18. 18.
    Collins FS. BRCA1—lots of mutations, lots of dilemmas. N Engl J Med. 1996;334:186–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Worthen HG. Inherited cancer and the primary care physician. Barriers and strategies. Cancer. 1999;86:2583–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Friedman LC, Woodruff A, Lane M, Weinberg AD, Cooper HP, Webb JA. Breast cancer screening behaviors and intentions among asymptomatic women 50 years of age and older. Am J Prev Med. 1995;11:218–23.PubMedGoogle Scholar
  21. 21.
    Love RR, Brown RL, Davis JE, Baumann LJ, Fontana SA, Sanner LA. Frequency and determinants of screening for breast cancer in primary care group practice. Arch Intern Med. 1993;153:2113–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Vernon SW. Participation in colorectal cancer screening: a review. J Natl Cancer Inst. 1997;89:1406–22.PubMedCrossRefGoogle Scholar
  23. 23.
    Kreuter MW, Chheda SG, Bull FC. How does physician advice influence patient behavior? Evidence for a priming effect. Arch Fam Med. 2000;9:426–33.PubMedCrossRefGoogle Scholar
  24. 24.
    Sweet KM, Bradley TL, Westman JA. Identification and referral of families at high risk for cancer susceptibility. J Clin Oncol. 2002;20:528–37.PubMedCrossRefGoogle Scholar
  25. 25.
    Westman J, Hampel H, Bradley T. Efficacy of a touchscreen computer based family cancer history questionnaire and subsequent cancer risk assessment. J Med Genet. 2000;37:354–60.PubMedCrossRefGoogle Scholar
  26. 26.
    Ryan EL, Skinner CS. Risk beliefs and interest in counseling: focus-group interviews among first-degree relatives of breast cancer patients. J Cancer Educ. 1999;14:99–103.PubMedGoogle Scholar
  27. 27.
    Todora HM, Skinner CS, Gidday L, Ivanovich JL, Rawl S, Whelan AJ. Perceptions of genetic risk assessment and education among first degree relatives of colorectal cancer patients and implications for physicians. Fam Pract. 2001;18:367–72.PubMedCrossRefGoogle Scholar
  28. 28.
    Harris MA, Byles JE. A survey of screening compliance among first degree relatives of people with colon cancer in New South Wales. J Med Screen. 1997;4:29–34.PubMedGoogle Scholar
  29. 29.
    Richardson JL, Danley K, Mondrus GT, Deapen D, Mack T. Adherence to screening examinations for colorectal cancer after diagnosis in a first-degree relative. Prev Med. 1995;24:166–70.PubMedCrossRefGoogle Scholar
  30. 30.
    Hampel H, Sweet K, Westman JA, Offit K, Eng C. Referral for cancer genetics consultation: a review and compilation of risk assessment criteria. J Med Genet. 2004;41:81–91.PubMedCrossRefGoogle Scholar
  31. 31.
    Berry DA, Iversen ES Jr, Gudbjartsson DF, et al. BRCAPRO validation, sensitivity of genetic testing of BRCA1/BRCA2, and prevalence of other breast cancer susceptibility genes. J Clin Oncol. 2002;20:2701–12.PubMedCrossRefGoogle Scholar
  32. 32.
    Parmigiani G, Berry D, Aguilar O. Determining carrier probabilities for breast cancer-susceptibility genes BRCA1 and BRCA2. Am J Hum Genet. 1998;62:145–58.PubMedCrossRefGoogle Scholar
  33. 33.
    Berry D, Parmigiani G, Sanchez J, Schildkraut J, Winer E. Probability of carrying a mutation of breast-ovarian cancer gene BRCA1 based on family history. J Natl Cancer Inst. 1997;89:227–38.PubMedCrossRefGoogle Scholar
  34. 34.
    Stokes M, David C, Koch G. Categorical Data Analysis Using the SAS System. 2nd ed. Cary, NC: SAS Institute Inc.; 2000:10–41.Google Scholar
  35. 35.
    Bastian LA, Lipkus IM, Kuchibhatla MN, et al. Women’s interest in chemoprevention for breast cancer. Arch Intern Med. 2001;161:1639–44.PubMedCrossRefGoogle Scholar
  36. 36.
    Haas JS, Kaplan C, Gregorich S, Perez-Stable E, Des Jarlais G. Do physicians tailor their recommendations for breast cancer risk reduction based on patient’s risk? J Gen Intern Med. 2004;19:302–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Campbell H, Holloway S, Cetnarskyj R, et al. Referrals of women with a family history of breast cancer from primary care to cancer genetics services in south-east Scotland. Br J Cancer. 2003;89:1650–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Watson E, Austoker J, Lucassen A. A study of GP referrals to a family cancer clinic for breast/ovarian cancer. Fam Pract. 2001;18:131–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Fry A, Campbell H, Gudmunsdottir H, et al. CPs’ views on their role in cancer genetics services and current practice. Fam Pract. 1999;16:468–74.PubMedCrossRefGoogle Scholar
  40. 40.
    Klabunde CN, Frame PS, Meadow A, Jones E, Nadel M, Vernon SW. A national survey of primary care physicians’ colorectal cancer screening recommendations and practices. Prev Med. 2003;36:352–62.PubMedCrossRefGoogle Scholar
  41. 41.
    Patel P, Forjuoh S, Avots-Avotins A, Patel T. Identifying opportunities for improved colorectal cancer screening in primary care. Prev Med. 2004;39:239–46.PubMedCrossRefGoogle Scholar
  42. 42.
    Ward J, Sanson-Fisher R. Does a 3-day workshop for family medicine trainees improve preventive care? A randomized control trial. Prev Med. 1996;25:741–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Daskalakis C, Goldberg RJ, Ockene JK, Kalan K, Hosmer DW Jr, Pbert L. Comparison of patients’ and their resident physicians’ responses regarding smoking-cessation interventions. Acad Med. 1993;68:168–70.PubMedCrossRefGoogle Scholar
  44. 44.
    Nicholson JM, Hennrikus DJ, Lando HA, McCarty MC, Vessey J. Patient recall versus physician documentation in report of smoking cessation counselling performed in the inpatient setting. Tob Control. 2000;9:382–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Roter DL, Russell NK. Validity of physician self-report in tracking patient education objectives. Health Educ Q. 1994;21:27–38.PubMedGoogle Scholar
  46. 46.
    Pbert L, Adams A, Quirk M, Hebert JR, Ockene JK, Luippold RS. The patient exit interview as an assessment of physician-delivered smoking intervention: a validation study. Health Psychol. 1999;18:183–8.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Celette Sugg Skinner
    • 1
    Email author
  • Susan M. Rawl
    • 2
  • Barry K. Moser
    • 1
  • Adam H. Buchanan
    • 1
  • Linda L. Scott
    • 2
  • Victoria L. Champion
    • 2
  • Joellen M. Schildkraut
    • 1
  • Giovanni Parmigiani
    • 3
  • Shelly Clark
    • 1
  • David F. Lobach
    • 1
  • Lori A. Bastian
    • 4
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.Indiana University School of NursingIndianapolisUSA
  3. 3.The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins UniversityBaltimoreUSA
  4. 4.Durham Veterans Affairs Medical CenterDurhamUSA

Personalised recommendations