title: Perceived versus objective breast cancer risk in diverse women.
abstract: BACKGROUND
  Prior research suggests that women do not accurately estimate their risk for breast cancer. Estimating and informing women of their risk is essential for tailoring appropriate screening and risk reduction strategies.
  
  
  METHODS
  Data were collected for BreastCARE, a randomized controlled trial designed to evaluate a PC-tablet based intervention providing multiethnic women and their primary care physicians with tailored information about breast cancer risk. We included women ages 40-74 visiting general internal medicine primary care clinics at one academic practice and one safety net practice who spoke English, Spanish, or Cantonese, and had no personal history of breast cancer. We collected baseline information regarding risk perception and concern. Women were categorized as high risk (vs. average risk) if their family history met criteria for referral to genetic counseling or if they were in the top 5% of risk for their age based on the Gail or Breast Cancer Surveillance Consortium Model (BCSC) breast cancer risk model.
  
  
  RESULTS
  Of 1,261 participants, 25% (N=314) were classified as high risk. More average risk than high risk women had correct risk perception (72% vs. 18%); 25% of both average and high risk women reported being very concerned about breast cancer. Average risk women with correct risk perception were less likely to be concerned about breast cancer (odds ratio [OR]=0.3; 95% confidence interval [CI]=0.2-0.4) while high risk women with correct risk perception were more likely to be concerned about breast cancer (OR=5.1; 95%CI=2.7-9.6).
  
  
  CONCLUSIONS
  Many women did not accurately perceive their risk for breast cancer. Women with accurate risk perception had an appropriate level of concern about breast cancer. Improved methods of assessing and informing women of their breast cancer risk could motivate high risk women to apply appropriate prevention strategies and allay unnecessary concern among average risk women.
authors.affiliation: 1 Department of Medicine, Division of General Internal Medicine, University of California , San Francisco, California.
authors.forename: Julia
authors.initials: J
authors.lastname: Fehniger
authors.forename: Jennifer
authors.initials: J
authors.lastname: Livaudais-Toman
authors.forename: Leah
authors.initials: L
authors.lastname: Karliner
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Tice
authors.forename: Jessica
authors.initials: J
authors.lastname: Quinn
authors.forename: Elissa
authors.initials: E
authors.lastname: Ozanne
authors.forename: Celia P
authors.initials: CP
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D010465:Perception; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires