title: What is my cancer risk? How internet-based cancer risk assessment tools communicate individualized risk estimates to the public: content analysis.
abstract: BACKGROUND
  Internet-based cancer risk assessment tools have the potential to inform the public about cancer risk and promote risk-reducing behaviors. However, poorly communicated information on these websites may result in unintended adverse health outcomes.
  
  
  OBJECTIVE
  This study examined whether: (1) Internet-based cancer risk assessment tools use risk communication formats that facilitate comprehension and reduce bias (as identified by the empirical literature); (2) the use of these formats varies by website affiliation; and (3) the websites provided information necessary to evaluate the quality of the risk estimate.
  
  
  METHODS
  A content analysis of Internet-based cancer risk assessment tools was conducted. The terms calculate cancer risk, cancer risk calculator, estimate cancer risk, assess cancer risk, and cancer risk assessment were searched using three search engines. We identified 47 risk assessment tools and coded each according to standardized criteria. We calculated simple frequencies on all coding categories and performed crosstabulations but did not conduct formal statistical analysis due to small cell sizes.
  
  
  RESULTS
  Use of risk communication formats that facilitate comprehension and reduce bias varied widely (eg, 30% of websites [14/47] provided absolute and comparative risk information but 83% [39/47] provided safety messages). Use of formats that facilitate comprehension varied by website affiliation and communication strategy (eg, only 8.3% [1/12] websites affiliated with the health care industry provided absolute and comparative risk information, but 83% [5/6] of websites affiliated with a governmental organization did so). Only 53% (25/47) of websites provided information about the statistical model or the peer-reviewed literature that was used to calculate the risk estimate.
  
  
  CONCLUSIONS
  Internet-based cancer risk assessment tools varied in their use of risk communication formats that facilitate comprehension and reduce bias. Formats that are difficult to understand may cause people to misperceive their cancer risk and consequently take inappropriate action.
authors.affiliation: Health Communication and Informatics Research Branch, National Cancer Institute, Bethesda, MD 20892-7365, USA. erika.a.waters@gmail.com
authors.forename: Erika A
authors.initials: EA
authors.lastname: Waters
authors.forename: Helen W
authors.initials: HW
authors.lastname: Sullivan
authors.forename: Wendy
authors.initials: W
authors.lastname: Nelson
authors.forename: Bradford W
authors.initials: BW
authors.lastname: Hesse
mesh_terms: D054598:Blue Cross Blue Shield Insurance Plans; D005260:Female; D006293:Health Promotion; D006801:Humans; D020407:Internet; D007802:Language; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D015203:Reproducibility of Results; D018570:Risk Assessment; D014481:United States; D014495:Universities
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