Self-rated breast cancer risk among women reporting a first-degree family history of breast cancer on office screening questionnaires in routine medical care: The role of physician-delivered risk feedback

Abstract

Purpose: We investigated whether risk-related feedback delivered by one's primary care physician is associated with self-ratings of risk among women found to have a first-degree family history of breast cancer on office screening questionnaires. Methods: Design: Mailed survey of women registered with the Cancer Genetics Network having a first-degree family history of breast cancer. Eligibility: Completion of primary care-based family history screening within the past year. Independent variable: presence of physician feedback about breast cancer risk.Dependent variable: self-rated breast cancer risk. Modifying variable: trust in one's doctor. Results: Three hundred one women met eligibility criteria (73% minimum response rate); feedback was associated with rating one's risk to be "high" in both crude and multivariate analysis. (OR adj ϭ 2.38; 95% CI ϭ 1.30, 4.38). Higher levels of trust in the physician were associated in a dose-dependent fashion with the strength of association between feedback and self-rating one's risk to be high. Conclusions: Physician feedback following the identification of a first-degree family history of breast cancer appears to influence whether or not women categorize themselves to be at high risk and trust is an important modifier of this association. Genet Med 2006:8(10):658-664.

Genetic cancer risk assessment in general practice: systematic review of tools available, clinician attitudes, and patient outcomes

“…54,55 Populations studied All studies involved both male and female patients or their GPs, except for one, 35 which comprised only female patients and female practitioners. Fourteen studies were carried out in the UK, 2,4,[20][21][22]25,34,41,44,[49][50][51]54,55 17 in North America, 9,15,23,[27][28][29][30][31]35,37,39,42,43,45,48,52,53 two in South America, 38,47 and two in Australia. 33,36 The remaining four were conducted in the European Union 26,32,40,46 (the Netherlands, Belgium, and Spain), and one study reported data from four countries across Europe, 24 namely the UK, France, Germany, and the Netherlands.…”

“…A variety of tools that could be used in general practice for screening genetic cancer risk was desc ribed. 15,29,30,38,39,[42][43][44][45][47][48][49][50][52][53][54][55] Examples of family-history collection tools included Family Healthware, 52,53 a self-administered web-based tool, and the seven-item Family History Screen (FHS-7) tool, 38 both of which cover family history of breast, ovarian, and colorectal cancer. MeTree -a computerised tool stratifying risk of hereditary cancer syndromes (that is, breast, ovarian, and colorectal cancer) to be completed at routine visits and to support clinical decisionswas used in three studies.…”

“…MeTree -a computerised tool stratifying risk of hereditary cancer syndromes (that is, breast, ovarian, and colorectal cancer) to be completed at routine visits and to support clinical decisionswas used in three studies. 42,45,48 Two studies examined an office screening form for familial breast cancer alone, 29,30 whereas one, by Walter et al, 50 developed a familyhistory questionnaire assessing breast and colorectal cancer to be completed at a planned data-collection session in the general practice surgery.…”

“…29,30,39,45,49,53 There was some evidence that screening can lead to higher accuracy for risk perceptions with risk feedback following an office screening form; there were greater odds of a patient correctly rating their breast cancer risk as 'high' in those who had an FDR with breast cancer. 30 Wang et al 53 found that, in comparison with patients in the control group, those who underestimated their risk and who were screened using the Family Healthware tool increased their perceptions of colon cancer risk, but not that relating to breast or ovarian cancer. Baer et al 39 found that, compared with the control group, a higher percentage of patients who had been screened via Your Health Snapshot reported their perceived risk of colon cancer to be above average -and possibly incorrectly.…”

Risk Communication During Screening for Genomic Breast Cancer Susceptibility

“…Furthermore, no association was found between the occurrence of feedback and the ratings women gave about their likelihood of developing breast cancer. 57 These fi ndings suggest that, independent of any discussion that might arise regarding the likelihood of developing breast cancer, the classifi cation of that risk as normal versus high is likely to have a substantial role in the shaping of women's perceptions.…”