Abstract B54: Concordance between objective and perceived breast cancer risk and breast cancer worry in racially diverse and immigrant women
Authors: April-Sanders Ayana K. , Tehranifar Parisa 
Published: May 2016

Abstract
Appropriate risk-based screening and risk-reducing interventions are important breast cancer (BC) prevention strategies. However, evidence suggests that many women inaccurately perceive their risk of BC, and that inaccurate perceptions of BC may be associated with inappropriately high or low levels of breast cancer worry, an important factor for health preventive behavior and psychological well-being. We used concordance between objective and perceived BC risk to measure accuracy of risk perception and examined whether accurate perceived risk was associated with BC worry in a predominantly racial minority (66% Hispanic, 16% black), and immigrant (63% foreign-born) sample of women (n=366, aged 40-64 years). We collected in-person interview data on perceived BC risk using the question, “Compared to the average woman your age, would you say that you are more likely to get breast cancer, less likely, or about as likely?”, and measured BC worry using the question “How often do you worry about getting breast cancer?”, with response options ranging from rarely or never to all the time. Objective risk was assessed through calculating 5-year risk estimates from the Gail model. Using the clinical threshold of ≥ 1.67%, 11% of the sample were categorized as high-risk (hereafter clinical high-risk). We also compared women's personal 5-year risk score to that of the 5-year risk score produced by the Gail model for an average women of the same age as participants, and categorized 23% of the sample as high-risk if personal risk score was ≥0.25 greater than the average women's risk score (hereafter comparative high-risk). Women whose risk scores did not meet the above thresholds were considered average-risk. We used binary and ordinal logistic regression to examine the association of concordance of perceived and objective risk with socioedemographic factors and BC worry. The majority of women (81%) correctly perceived their risk, with the proportion of correct risk perception higher in average-risk women (87%) than in high-risk women (36%). Accurate risk perception (i.e., concordance between perceived and objective risk) was lowest in women who were U.S.-born, English-speakers, had higher health literacy and were non-Hispanic white (e.g., 55% of whites vs. 88% and 78% in Hispanic and African American women respectively had correct risk perceptions relative to clinical risk). Women with family history of BC were also more likely to have inaccurate perceived risk (57% vs. 85%). Compared to average-risk women with low perceived risk, women who perceive their BC risk to be high, regardless of their objective risk, had higher BC worry while women with low perceived risk but high objective risk had lower BC worry. After adjusting for race/ethnicity, language acculturation, education and family history, average-risk women who perceived themselves to be at higher risk continued to have statistically significantly higher odds of BC worry (OR=3.00, 95% CI:1.60-5.62 for clinical risk, and OR=3.96, 95% CI: 1.96-7.98 for comparative risk, both relative to average-risk women with low perceived risk). In conclusion, while the majority of women correctly perceived their risk for breast cancer, a substantial proportion of high-risk women inaccurately perceived themselves to be at average risk and/or lower risk than average women of the same age. High perceived risk predicted higher BC worry in both average- and high-risk women. Increasing women's knowledge of their breast cancer risk may improve inaccurate risk perception and inappropriate BC worry, and help women better appraise their risk management options.
Citation Format: Ayana K. April-Sanders, Parisa Tehranifar. Concordance between objective and perceived breast cancer risk and breast cancer worry in racially diverse and immigrant women. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B54.