Karen Kaiser1, Kenzie A Cameron2,3, Jennifer Beaumont4, Sofia F Garcia2, Leilani Lacson2, Margaret Moran5, Lindsey Karavites6, Chiara Rodgers7, Swati Kulkarni8, Nora M Hansen8, Seema A Khan8. 1. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, 60611, Chicago, IL, USA. k-kaiser@northwestern.edu. 2. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, 60611, Chicago, IL, USA. 3. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 4. Terasaki Research Institute, Los Angeles, CA, USA. 5. Oak Street Health, Chicago, IL, USA. 6. Sinai Health System, Chicago, IL, USA. 7. American Association of Hip and Knee Surgeons, Chicago, IL, USA. 8. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Abstract
PURPOSE: Newly diagnosed breast cancer patients greatly overestimate their risk of developing contralateral breast cancer (CBC). Better understanding of patient conceptions of risk would facilitate doctor-patient communication and surgical decision making. In this mixed methods study, we prospectively examined breast cancer patients' perceived risk of future cancer and the reported factors that drove their risk perceptions. METHODS: Women age 21-60 diagnosed with breast cancer without a BRCA mutation or known distant metastases completed a study interview between surgical consult and surgical treatment. Participants completed a 12-item Perceived Risk Questionnaire, which assessed 10-year and lifetime risks of ipsilateral local recurrence, CBC, and distant recurrence. Patients provided qualitative explanations for their answers. RESULTS: Sixty-three patients completed study interviews (mean age 50.3). Participants were primarily White (85.7%) and 90.5% had attended college. Patients estimated their 10-year risk of CBC as 22.0%, nearly 4 times the established 10-year risk. Women attributed their risk perceptions to "gut feelings" about future cancer, even when women knew those feelings contradicted medically established risk. Perceptions of risk also reflected beliefs that cancer is random and that risk for local recurrence, CBC, and distant recurrence are the same. CONCLUSIONS: Our findings point to the need for novel ways of presenting factual information regarding both risk of recurrence and of new primary cancers, as well as the necessity of acknowledging cognitive and affective processes many patients use when conceptualizing risk. By differentiating women's intuitive feelings about risk from their knowledge of medically estimated risk, doctors can enhance informed decision making.
PURPOSE: Newly diagnosed breast cancerpatients greatly overestimate their risk of developing contralateral breast cancer (CBC). Better understanding of patient conceptions of risk would facilitate doctor-patient communication and surgical decision making. In this mixed methods study, we prospectively examined breast cancerpatients' perceived risk of future cancer and the reported factors that drove their risk perceptions. METHODS:Women age 21-60 diagnosed with breast cancer without a BRCA mutation or known distant metastases completed a study interview between surgical consult and surgical treatment. Participants completed a 12-item Perceived Risk Questionnaire, which assessed 10-year and lifetime risks of ipsilateral local recurrence, CBC, and distant recurrence. Patients provided qualitative explanations for their answers. RESULTS: Sixty-three patients completed study interviews (mean age 50.3). Participants were primarily White (85.7%) and 90.5% had attended college. Patients estimated their 10-year risk of CBC as 22.0%, nearly 4 times the established 10-year risk. Women attributed their risk perceptions to "gut feelings" about future cancer, even when women knew those feelings contradicted medically established risk. Perceptions of risk also reflected beliefs that cancer is random and that risk for local recurrence, CBC, and distant recurrence are the same. CONCLUSIONS: Our findings point to the need for novel ways of presenting factual information regarding both risk of recurrence and of new primary cancers, as well as the necessity of acknowledging cognitive and affective processes many patients use when conceptualizing risk. By differentiating women's intuitive feelings about risk from their knowledge of medically estimated risk, doctors can enhance informed decision making.
Entities:
Keywords:
Breast cancer; Contralateral prophylactic mastectomy; Patient education; Risk
Authors: Eileen Rakovitch; Edmee Franssen; John Kim; Ida Ackerman; Jean-Philippe Pignol; Lawrence Paszat; Kathleen I Pritchard; Cindy Ho; Donald A Redelmeier Journal: Breast Cancer Res Treat Date: 2003-02 Impact factor: 4.872
Authors: Stewart J Anderson; Irene Wapnir; James J Dignam; Bernard Fisher; Eleftherios P Mamounas; Jong-Hyeon Jeong; Charles E Geyer; D Lawrence Wickerham; Joseph P Costantino; Norman Wolmark Journal: J Clin Oncol Date: 2009-04-06 Impact factor: 44.544
Authors: Ying Liu; Maria Pérez; Rebecca L Aft; Kerry Massman; Erica Robinson; Stephanie Myles; Mario Schootman; William E Gillanders; Donna B Jeffe Journal: Cancer Epidemiol Biomarkers Prev Date: 2010-02-16 Impact factor: 4.254
Authors: Hava Izci; Tim Tambuyzer; Krizia Tuand; Victoria Depoorter; Annouschka Laenen; Hans Wildiers; Ignace Vergote; Liesbet Van Eycken; Harlinde De Schutter; Freija Verdoodt; Patrick Neven Journal: J Natl Cancer Inst Date: 2020-10-01 Impact factor: 13.506
Authors: David W Lim; Helene Retrouvey; Isabel Kerrebijn; Kate Butler; Anne C O'Neill; Tulin D Cil; Toni Zhong; Stefan O P Hofer; David R McCready; Kelly A Metcalfe Journal: Ann Surg Oncol Date: 2021-04-05 Impact factor: 5.344