Perceptions of Breast Cancer Risks Among Women Receiving Mammograph Screening

Abstract

ImportanceBreast density is an independent risk factor for breast cancer. Despite the proliferation of mandated written notifications about breast density following mammography, there is little understanding of how women perceive the relative breast cancer risk associated with breast density.ObjectiveTo assess women’s perception of breast density compared with other breast cancer risks and explore their understanding of risk reduction.Design, Setting, and ParticipantsThis mixed-methods qualitative study used telephone surveys and semistructured interviews to investigate perceptions about breast cancer risk among a nationally representative, population-based sample of women. Eligible study participants were aged 40 to 76 years, reported having recently undergone mammography, had no history of prior breast cancer, and had heard of breast density. Survey participants who had been informed of their personal breast density were invited for a qualitative interview. Survey administration spanned July 1, 2019, to April 30, 2020, with 2306 women completing the survey. Qualitative interviews were conducted from February 1 to May 30, 2020.Main Outcomes and MeasuresRespondents compared the breast cancer risk associated with breast density with 5 other risk factors. Participants qualitatively described what they thought contributed to breast cancer risk and ways to reduce risk.ResultsOf the 2306 women who completed the survey, 1858 (166 [9%] Asian, 503 [27%] Black, 268 [14%] Hispanic, 792 [43%] White, and 128 [7%] other race or ethnicity; 358 [19%] aged 40-49 years, 906 [49%] aged 50-64 years, and 594 [32%] aged ≥65 years) completed the revised risk perception questions and were included in the analysis. Half of respondents thought breast density to be a greater risk than not having children (957 [52%]), having more than 1 alcoholic drink per day (975 [53%]), or having a prior breast biopsy (867 [48%]). Most respondents felt breast density was a lesser risk than having a first-degree relative with breast cancer (1706 [93%]) or being overweight or obese (1188 [65%]). Of the 61 women who were interviewed, 6 (10%) described breast density as contributing to breast cancer risk, and 43 (70%) emphasized family history as a breast cancer risk factor. Of the interviewed women, 17 (28%) stated they did not know whether it was possible to reduce their breast cancer risk.Conclusions and RelevanceIn this qualitative study of women of breast cancer screening age, family history was perceived as the primary breast cancer risk factor. Most interviewees did not identify breast density as a risk factor and did not feel confident about actions to mitigate breast cancer risk. Comprehensive education about breast cancer risks and prevention strategies is needed.

Population Attributable Risk of Advanced-Stage Breast Cancer by Race and Ethnicity

“…Family history of breast cancer accounted for a small proportion of advanced breast cancers in premenopausal (8%) and postmenopausal women (5%) in our study. Studies have shown that women perceive family history of breast cancer as the primary breast cancer risk factor, with overweight/obesity and breast density less likely to be identified as primary risk factors for breast cancer . Patients need to be educated on factors that contribute most to development of advanced breast cancer (eg, having overweight/obesity and high breast density) and on primary prevention interventions that can modify these risk factors.…”

“I haven’t had that information, even though I think I’m really well-informed about most things”: a qualitative focus group study on Australian women’s understanding and views of potentially modifiable risk factors for breast cancer

“…Findings, similar to previously mentioned work [ 24 ], highlight that a multi-pronged approach to communication is likely to be needed to reach women of all ages, socioeconomic status, and health and media literacy levels. However, it is known that knowledge of breast cancer risk factors or intention to modify behavioural factors does not guarantee actual lifestyle change, that there has generally been a lack of awareness among women of lifestyle behaviour change as a form of breast cancer prevention [ 6 ], and women do not feel confident about actions they can take to mitigate breast cancer risk [ 29 ]. Therefore, well developed and accessible interventions are needed to facilitate this.…”

Effects of interventions on the screening behavior in female first‐degree relatives of breast cancer patients: A systematic review

“…BC is a multi‐factorial disease (Hao et al., 2021), and family history is an important and unmodifiable risk factor (Beidler et al., 2023). Female FDRs, including mothers, sisters, and daughters of BC patients, have a 1.5‐ to 3‐fold greater risk of developing BC during their lifetime than the general population (Braithwaite et al., 2018).…”

“…Mammography, clinical breast examination (CBE), and breast self-examination (BSE) are considered to be effective strategies for the early detection of BC (Zhou et al, 2014). In response to the rising incidence of BC, many countries have implemented national BC screening programs, such as the USA, Australia (Australian Government, 2020), most of the European Union countries , and China BC is a multi-factorial disease (Hao et al, 2021), and family history is an important and unmodifiable risk factor (Beidler et al, 2023). Female FDRs, including mothers, sisters, and daughters of BC patients, have a 1.5-to 3-fold greater risk of developing BC during their lifetime than the general population (Braithwaite et al, 2018).…”