Frequency of Breast Cancer Thoughts and Lifetime Risk Estimates: A Multi-Institutional Survey of Women Undergoing Screening Mammography

Authors: Lars J. Grimm, MD, MHSa, MD, MHS Lars J. GrimmEmail the author MD, MHS Lars J. Grimm, Rebecca A. Shelby, PhDb, Emily E. Knippa, MDc, Eun L. Langman, MDd, Lauren S. Miller, MDe, Beth A. Whiteside, MDf, Mary Scott Soo, MDa


Purpose
The aim of this study was to quantify women’s personal estimates of breast cancer risk and frequency of breast cancer thoughts.

Methods
Women from five medical centers were surveyed before their screening mammographic examinations. Participants were queried on their baseline anxiety and demographics, then asked how many times in the past month they had thought about developing breast cancer. Participants were then notified of the 12% lifetime average breast cancer risk and asked to estimate their personal risk both subjectively and objectively. Comparisons were made between responses and the demographic variables.

Results
There were 2,747 completed surveys for analysis. Women reported 2.5 ± 6.6 thoughts of cancer on average in the prior month. More frequent thoughts were associated with personal or family history of breast cancer, greater anxiety, and genetic testing (P < .001 for all). Among women without cancer risk factors (n = 1,412), there were 1.4 cancer thoughts per month, which was associated with baseline anxiety (P < .001). The median lifetime breast cancer risk was 12% among all women, with 37.4% high risk (>20%) estimates. Demographic variables associated with increased risk estimates were previous cancer diagnosis, higher education, genetic testing, white race, increased age, and greater anxiety (P < .01 for all). Among women with no risk factors, the median estimated risk was 10%, with 16.7% providing estimates greater than 20%, associated with baseline anxiety and white race (P < .001 for both).

Conclusions
Increased breast cancer thoughts and personal cancer estimates are associated with specific patient demographics. Improved understanding of patient perspectives could improve shared decision-making discussions and thus patient care.