Breast cancer risk perception: what do we know and understand?

Our perceptions of breast cancer risk are largely inaccurate and are often associated with high levels of anxiety about cancer. There are interesting cultural differences that are not well researched. Genetic risk counselling significantly improves accuracy of women’s perceptions of risk, but not necessarily to the correct level. Reasons for this are unclear, but may relate to personal beliefs about susceptibility and to problems or variations in risk communication. Research into the impact of demographic and psychological factors on risk perception has been inconclusive. An understanding of the process of developing a perception of risk would help to inform risk counselling strategies. This is important, because knowledge of risk is needed both for appropriate health care decision making and to reassure women who are not at increased risk.

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  • Factors associated with the perception of risk
  • The experience of cancer in the family
  • Less common types of Breast Cancer
  • Role of genetic risk counselling
  • Role of truGeny

Factors associated with the perception of risk

Individuals with strong family histories may acknowledge an increase in risk, but frequently think in non-Mendelian terms and are more influenced by their particular familial experience of the condition. Their perceived vulnerability may be based on the burden of cancer in the family rather than on the hereditary nature of a faulty gene. This will help to explain why some women do not adjust their risk to the value given by the genetic counsellor. A number of other factors have been explored for their possible association with risk perception, including demographic and psychological factors, coping and cognitive factors and heuristic factors. The impact on risk perception of anxiety proneness, ‘state’ anxiety (ie anxiety at a particular moment, such as when attending for risk counselling), prior mental health, age, the number of affected relatives and the individual doctor who is communicating risk information have been evaluated, but no conclusive associations have been identified.

The experience of cancer in the family

The timing of illness events and deaths in cancer-prone families is often an important triggering factor in consideration of personal risk and in seeking risk assessment and advice on risk management or cancer prevention. Women’s perceptions of vulnerability may be developed from this ‘lived experience’ of cancer and through strong identification with an affected or deceased mother or sister. This is congruent with findings in other genetic conditions, in which the ‘availability heuristic’ has been found to influence risk perception. This means that people judge an experience that is cognitively ‘available’ (ie can be remembered) as more likely to occur, and beliefs about the frequency of lethal events may lead to overestimation of risk of disease occurrence or of the seriousness of the risk. Moreover, the perception of the severity of the disorder tends to be included in the interpretation of the risk, irrespective of the risk value given at genetic counselling. Thus, both cognitive and emotional factors interplay in the formulation of risk perception.

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Role of genetic risk counselling

The positive impact of genetic risk counselling on risk accuracy has been shown repeatedly, and additional information in the form of a personal letter or audiotape of the consultation, or a more general video presentation have all been shown to confer additional small benefits in accuracy of risk perception. They may help to reduce factual inaccuracies and reinforce retention of correct information. It remains to be seen whether new forms of risk presentation using innovative computer graphics can improve on these results. The most effective methods of presenting risk information to women who continue to overestimate or underestimate are still to be determined, but an important initiative has recently been taken by the American Cancer Society to try to develop a consensus communications model that provides guidance for breast cancer risk communication. The recommendations include the avoidance of the concept of lifetime risk; use of absolute risk in preference to relative risk; an agreed definition of ‘high risk’, which is based on the need to take different action from the average woman and the use of comparison risks for other diseases. These recommendations follow logically from published research in the field, and will have implications for the delivery of risk information both in educating the general population and in personalised genetic risk counselling.

Role of truGeny

trugeny is a telegentic platform of India that provides a complete solution for Genetic Counselling and Testing Services. Our expert counsellor goes through a thorough investigation of you and your family’s medical history. They diagnose the risk of you being susceptible to Breast Cancer or any other Genetic disorder. Based on the counselling report, Testing is advised. Post the testing, the results are again briefed to you for a clear understanding of your health. Further, the experts will also guide you through your future decisions.

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