Department of Medicine, Washington University School of Medicine, St. Louis, MO 63108, USA.
Cancer Epidemiol Biomarkers Prev. 2010 Mar;19(3):675-80. doi: 10.1158/1055-9965.EPI-09-1051. Epub 2010 Feb 16.
Accurate breast cancer recurrence risk perceptions might motivate health-promoting behaviors and alleviate undue anxiety. Although a few studies have examined early-stage breast cancer survivors' perceived risk of recurrence, none have assessed the accuracy of survivors' perceived risk of recurrence.
First primary ductal carcinoma in situ and early-invasive breast cancer survivors reported their perceived risk of recurrence during 6- and 12-month postsurgery interviews. We estimated the patients' 10-year risk of recurrence from published clinical trials, and for early-invasive breast cancer patients, risk of distant recurrence was based on their breast cancer-specific mortality calculated using Adjuvant! Online. Patients' perceived risk was compared with their calculated risk and categorized as "Accurate," "Underestimated," "Overestimated," and "Uncertain." Multinomial logit marginal effect models were fitted using Accurate as the reference.
Only 17% of 531 patients accurately perceived their risk at 6 months, most of whom inaccurately perceived their risk at 12 months (P = 0.0143). Patients who were nonwhite [odds ratio (OR), 1.70; 95% confidence interval (95% CI), 1.12-2.56] and received radiation therapy (OR, 2.01; 95% CI, 1.07-3.77) were more likely to underestimate their risk. Patients with ductal carcinoma in situ (OR, 1.76; 95% CI, 1.11-2.79), [corrected] lower social support (OR, 0.71; 95% CI, 0.53-0.95), and anxiety (OR, 1.58; 95% CI, 1.01-2.47) were more likely to overestimate their risk.
Few breast cancer survivors accurately perceived their risk of recurrence.
The accuracy of perceived risk may be increased by better physician-patient communications about their prognosis, provision of social support, and treatment for coexisting anxiety.
准确的乳腺癌复发风险感知可能会激发促进健康的行为，并减轻不必要的焦虑。尽管有几项研究调查了早期乳腺癌幸存者对复发的感知风险，但没有一项研究评估过幸存者对复发风险的感知准确性。
首先对原发性导管原位癌和早期浸润性乳腺癌幸存者在术后 6 个月和 12 个月的访谈中报告其对复发的感知风险。我们根据发表的临床试验估算了患者的 10 年复发风险，对于早期浸润性乳腺癌患者，基于其使用 Adjuvant! Online 计算的乳腺癌特异性死亡率来估算远处复发风险。将患者的感知风险与计算风险进行比较，并分为“准确”、“低估”、“高估”和“不确定”。使用“准确”作为参考，拟合多项逻辑边际效应模型。
531 例患者中，只有 17%的患者在 6 个月时准确感知风险，其中大多数在 12 个月时不准确感知风险（P=0.0143）。非白人患者（比值比，1.70；95%置信区间，1.12-2.56）和接受放疗的患者（比值比，2.01；95%置信区间，1.07-3.77）更有可能低估风险。患有导管原位癌（比值比，1.76；95%置信区间，1.11-2.79）、较低的社会支持（比值比，0.71；95%置信区间，0.53-0.95）和焦虑（比值比，1.58；95%置信区间，1.01-2.47）的患者更有可能高估风险。
少数乳腺癌幸存者准确感知其复发风险。
通过更好的医患沟通了解其预后、提供社会支持和治疗共存的焦虑，可能会提高感知风险的准确性。
