"Don't know" and accuracy of breast cancer risk perceptions among Appalachian women attending a mobile mammography program: implications for educational interventions and patient empowerment.

Risk perceptions are motivating factors for engaging in preventive health behaviors. Yet, almost one third of women attending a mobile mammography program targeted to rural and medically underserved Appalachian women respond "don't know" to their perceived 5-year risk of breast cancer. This study used cross-sectional data from women aged >40 years participating in Bonnie's Bus Mammography Screening and Preventive Care Survey from 2009 to 2011 to identify factors associated with "don't know" responses and accuracy of perceived risk according to constructs of the health belief model and sociodemographic characteristics. Women who responded "don't know" were more likely to be less educated, of lower income, insured by Medicaid, and less knowledgeable about breast cancer. Conversely, women who accurately perceived their risk were more likely to be of higher education, more knowledgeable about breast cancer, and have a family history of breast cancer. However, women with a high objective 5-year risk of breast cancer and older age at childbirth or were nulliparous were less likely to accurately perceive their risk. These findings suggest that women who indicate "don't know" responses and hold inaccurate risk perceptions are a population vulnerable to health disparities and may benefit from educational interventions focused on improving breast cancer knowledge and perceptions to empower them to take an active role in their preventive health and make informed decisions based on their individual level of risk.