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01-03-2007 | Original Article

Missed Opportunities: Family History and Behavioral Risk Factors in Breast Cancer Risk Assessment Among a Multiethnic Group of Women

Authors: Leah S. Karliner, MD, MAS, Anna Napoles-Springer, PhD, Karla Kerlikowske, MD, Jennifer S. Haas, MD, Steven E. Gregorich, PhD, Celia Patricia Kaplan, DrPH, MA

Published in: Journal of General Internal Medicine | Issue 3/2007

Background

Clinician’s knowledge of a woman’s cancer family history (CFH) and counseling about health-related behaviors (HRB) is necessary for appropriate breast cancer care.

Objective

To evaluate whether clinicians solicit CFH and counsel women on HRB; to assess relationship of well visits and patient risk perception or worry with clinician’s behavior.

Design

Cross-sectional population-based telephone survey.

Participants

Multiethnic sample; 1,700 women from San Francisco Mammography Registry with a screening mammogram in 2001–2002.

Measurements

Predictors: well visit in prior year, self-perception of 10-year breast cancer risk, worry scale. Outcomes: Patient report of clinician asking about CFH in prior year, or ever counseling about HRB in relation to breast cancer risk. Multivariate models included age, ethnicity, education, language of interview, insurance/mammography facility, well visit, ever having a breast biopsy/follow-up mammography, Gail-Model risk, Jewish heritage, and body mass index.

Results

58% reported clinicians asked about CFH; 33% reported clinicians ever discussed HRB. In multivariate analysis, regardless of actual risk, perceived risk, or level of worry, having had a well visit in prior year was associated with increased odds (OR = 2.3; 95% CI 1.6, 3.3) that a clinician asked about CFH. Regardless of actual risk of breast cancer, a higher level of worry (OR = 1.9; 95% CI 1.4, 2.6) was associated with increased odds that a clinician ever discussed HRB.

Conclusions

Clinicians are missing opportunities to elicit family cancer histories and counsel about health-related behaviors and breast cancer risk. Preventive health visits offer opportunities for clinicians to address family history, risk behaviors, and patients’ worries about breast cancer.

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Title: Missed Opportunities: Family History and Behavioral Risk Factors in Breast Cancer Risk Assessment Among a Multiethnic Group of Women
Authors: Leah S. Karliner, MD, MAS
Anna Napoles-Springer, PhD
Karla Kerlikowske, MD
Jennifer S. Haas, MD
Steven E. Gregorich, PhD
Celia Patricia Kaplan, DrPH, MA
Publication date: 01-03-2007
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 3/2007
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-006-0087-y

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