title: Missed opportunities: family history and behavioral risk factors in breast cancer risk assessment among a multiethnic group of women.
abstract: 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.
  
  
  METHODS
  Cross-sectional population-based telephone survey.
  
  
  METHODS
  Multiethnic sample; 1,700 women from San Francisco Mammography Registry with a screening mammogram in 2001-2002.
  
  
  METHODS
  
  
  
  METHODS
  well visit in prior year, self-perception of 10-year breast cancer risk, worry scale.
  
  
  RESULTS
  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.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California, USA.
authors.forename: Leah S
authors.initials: LS
authors.lastname: Karliner
authors.forename: Anna
authors.initials: A
authors.lastname: Napoles-Springer
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gregorich
authors.forename: Celia Patricia
authors.initials: CP
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012309:Risk-Taking