title: General Practitioners and Breast Surgeons in France, Germany, Netherlands and the UK show variable breast cancer risk communication profiles.
abstract: BACKGROUND
  No information is available on the attitudes of General Practitioners (GPs) and Breast Surgeons (BSs) to their delivery of genetic, environmental and lifestyle risk factor information about breast cancer. The aim of this study was to describe the Breast Cancer Risk Communication Behaviours (RCBs) reported by GPs and BSs in four European countries and to determine the relationships between their RCBs and their socio-occupational characteristics.
  
  
  METHODS
  Self-administered questionnaires assessing breast cancer risk communication behaviours using vignettes were mailed to a sample of Breast Surgeons (BS) and General Practitioners (GP) working in France, Germany, the Netherlands, and the UK (N = 7292). Their responses to questions about the risk factors were first ordered and compared by specialty and country after making multivariate adjustments. Rather than defining a standard Risk Presentation Format (RPF) a priori, the various RPFs used by the respondents were analyzed using cluster analysis.
  
  
  RESULTS
  Family history and hormonal replacement therapy were the risk factors most frequently mentioned by the 2094 respondents included in this study. Lifestyle BC risk factors such as obesity and alcohol were rarely/occasionally mentioned, but this point differed (p < 0.001) depending on the country and the specialty of the providers involved. Five distinct RPF profiles including the numerical/verbal presentation of absolute/relative risks were identified. The most frequently encountered RPF (34.2%) was characterized by the fact that it included no negative framing of the risks, i.e., the probability of not developing cancer was not mentioned. Age, specialty and country of practice were all found to be significant determinants of the RPF clusters.
  
  
  CONCLUSIONS
  The increasing trend for GPs and BSs to discuss lifestyle risk factors with their patients suggests that this may be a relevant means of improving breast cancer prevention. Physicians' risk communication skills should be improved during their initial and vocational training.
authors.affiliation: Institut Paoli-Calmettes, UMR_S 912, 232 Boulevard Sainte Marguerite, 13009, Marseille, France. claire.julian-reynier@inserm.fr.|INSERM, UMR_S 912, Marseille, France. claire.julian-reynier@inserm.fr.|Aix-Marseille Université, UMR_S 912, Marseille, France. claire.julian-reynier@inserm.fr.
authors.forename: Claire
authors.initials: C
authors.lastname: Julian-Reynier
authors.affiliation: INSERM, UMR_S 912, Marseille, France. anne-deborah.bouhnik@inserm.fr.|Aix-Marseille Université, UMR_S 912, Marseille, France. anne-deborah.bouhnik@inserm.fr.
authors.forename: Anne-Deborah
authors.initials: AD
authors.lastname: Bouhnik
authors.affiliation: Department of Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, St. Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK. Gareth.Evans@cmft.nhs.uk.
authors.forename: D Gareth
authors.initials: DG
authors.lastname: Evans
authors.affiliation: GenEd Coordinating Centre, University of Manchester, Manchester, UK. hilaryharris@btinternet.com.
authors.forename: Hilary
authors.initials: H
authors.lastname: Harris
authors.affiliation: Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands. C.J.van_Asperen@lumc.nl.
authors.forename: Christi J
authors.initials: CJ
authors.lastname: van Asperen
authors.affiliation: Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands. A.Tibben@lumc.nl.
authors.forename: Aad
authors.initials: A
authors.lastname: Tibben
authors.affiliation: Institute of Human Genetics, Hannover Medical School, Hannover, Germany. Schmidtke.Joerg@mh-hannover.de.
authors.forename: Joerg
authors.initials: J
authors.lastname: Schmidtke
authors.affiliation: Women's Health Research, Münster Medical School, Münster, Germany. nippert@uni-muenster.de.
authors.forename: Irmgard
authors.initials: I
authors.lastname: Nippert
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology*; D005260:Female; D005602:France; D058005:General Practitioners; D005858:Germany; D058015:Health Communication; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012306:Risk; D066231:Surgeons; D011795:Surveys and Questionnaires; D006113:United Kingdom