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

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Background

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.

Objective

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.

Design

Cross-sectional population-based telephone survey.

Participants

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

Measurements

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.

Results

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.

Conclusions

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.

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Acknowledgments

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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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California, USA

    Leah S. Karliner MD, MAS, Anna Napoles-Springer PhD, Steven E. Gregorich PhD & Celia Patricia Kaplan DrPH, MA

  2. UCSF Comprehensive Cancer Center, University of California, San Francisco, California, USA

    Anna Napoles-Springer PhD & Celia Patricia Kaplan DrPH, MA

  3. General Internal Medicine Section, Department of Veterans’ Affairs, University of California, San Francisco, California, USA

    Karla Kerlikowske MD

  4. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

    Karla Kerlikowske MD

  5. Department of Medicine, University of California, San Francisco, California, USA

    Karla Kerlikowske MD

  6. Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA

    Jennifer S. Haas MD

Authors
  1. Leah S. Karliner MD, MAS
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  2. Anna Napoles-Springer PhD
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  3. Karla Kerlikowske MD
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  4. Jennifer S. Haas MD
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  5. Steven E. Gregorich PhD
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  6. Celia Patricia Kaplan DrPH, MA
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Corresponding author

Correspondence to Celia Patricia Kaplan DrPH, MA.

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Karliner, L.S., Napoles-Springer, A., Kerlikowske, K. et al. Missed Opportunities: Family History and Behavioral Risk Factors in Breast Cancer Risk Assessment Among a Multiethnic Group of Women. J GEN INTERN MED 22, 308–314 (2007). https://doi.org/10.1007/s11606-006-0087-y

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  • DOI: https://doi.org/10.1007/s11606-006-0087-y

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