Underestimation of breast cancer risk: influence on screening behavior.

PURPOSE/OBJECTIVES To describe perceived breast cancer risk, identify the percentage of women with inaccurate risk perceptions, and examine the influence of perceived and objective risk on screening behavior. DESIGN Descriptive, correlational, cross-sectional. SETTING Community settings in a metropolitan area on the western coast of the United States. SAMPLE Multicultural sample of 184 English-speaking women (57% non-Caucasian, X age = 47 +/- 12 years) who have never been diagnosed with cancer. METHODS Two perceived risk scales (verbal and comparative) and the Gail model were used to assess perceived and objective breast cancer risk, respectively. MAIN RESEARCH VARIABLES Perceived breast cancer risk, objective breast cancer risk, screening behavior. FINDINGS Participants reported that they "probably will not" get breast cancer and that their risk was "somewhat lower" than average. Family history of breast cancer was a significant predictor of perceived risk. Demographic characteristics and objective risk factors were not associated with perceived risk. Most women at high risk for breast cancer (89%) underestimated their actual risk; fewer women with low to average risk for breast cancer (9%) overestimated their risk. Age, Gail scores, and health insurance status promoted breast cancer screening; underestimation of risk had the opposite effect. CONCLUSIONS Inaccurate perceptions of risk do not promote optimal breast cancer screening. The finding has implications for most women at high risk for developing breast cancer who underestimate their risk. IMPLICATIONS FOR NURSING Oncology nurses can use risk assessment tools to provide individualized counseling regarding breast cancer risk factors and screening. Women at high risk who underestimate their risk could benefit from additional screening and from advances in cancer chemoprevention.