Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, 60611, Chicago, IL, USA.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Breast Cancer Res Treat. 2019 Jun;175(3):579-584. doi: 10.1007/s10549-019-05182-3. Epub 2019 Mar 6.
Newly diagnosed breast cancer patients greatly overestimate their risk of developing contralateral breast cancer (CBC). Better understanding of patient conceptions of risk would facilitate doctor-patient communication and surgical decision making. In this mixed methods study, we prospectively examined breast cancer patients' perceived risk of future cancer and the reported factors that drove their risk perceptions.
Women age 21-60 diagnosed with breast cancer without a BRCA mutation or known distant metastases completed a study interview between surgical consult and surgical treatment. Participants completed a 12-item Perceived Risk Questionnaire, which assessed 10-year and lifetime risks of ipsilateral local recurrence, CBC, and distant recurrence. Patients provided qualitative explanations for their answers.
Sixty-three patients completed study interviews (mean age 50.3). Participants were primarily White (85.7%) and 90.5% had attended college. Patients estimated their 10-year risk of CBC as 22.0%, nearly 4 times the established 10-year risk. Women attributed their risk perceptions to "gut feelings" about future cancer, even when women knew those feelings contradicted medically established risk. Perceptions of risk also reflected beliefs that cancer is random and that risk for local recurrence, CBC, and distant recurrence are the same.
Our findings point to the need for novel ways of presenting factual information regarding both risk of recurrence and of new primary cancers, as well as the necessity of acknowledging cognitive and affective processes many patients use when conceptualizing risk. By differentiating women's intuitive feelings about risk from their knowledge of medically estimated risk, doctors can enhance informed decision making.
新诊断的乳腺癌患者极大地高估了他们患对侧乳腺癌（CBC）的风险。更好地了解患者对风险的看法将有助于医患沟通和手术决策。在这项混合方法研究中，我们前瞻性地检查了乳腺癌患者对未来癌症的感知风险以及报告的驱动其风险感知的因素。
年龄在 21-60 岁之间、诊断为乳腺癌且没有 BRCA 突变或已知远处转移的女性在手术咨询和手术治疗之间完成了一项研究访谈。参与者完成了 12 项感知风险问卷，评估了同侧局部复发、CBC 和远处复发的 10 年和终身风险。患者为他们的答案提供了定性解释。
63 名患者完成了研究访谈（平均年龄 50.3 岁）。参与者主要是白人（85.7%），90.5%的人上过大学。患者估计他们的 10 年 CBC 风险为 22.0%，几乎是既定的 10 年风险的 4 倍。女性将她们的风险感知归因于对未来癌症的“直觉”，即使她们知道这些感觉与医学上确定的风险相矛盾。风险感知也反映了这样的信念，即癌症是随机的，局部复发、CBC 和远处复发的风险是相同的。
我们的研究结果表明，需要用新的方法来呈现关于复发风险和新发原发性癌症的风险的事实信息，并且有必要承认许多患者在概念化风险时使用的认知和情感过程。通过将女性对风险的直觉感受与她们对医学估计风险的了解区分开来，医生可以增强知情决策。
