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Duke University Medical Center, Durham, North Carolina 27701 [I. M. L., M. K., C. M. M., H. B. B., K. I. P., I. C. S.], and National Cancer Institute, Bethesda, Maryland 20892 [B. K. R.]
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Abstract |
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 Top Abstract IntroductionMaterials and MethodsResultsDiscussionReferences |
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Introduction |
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TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
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Studies exploring perceived breast cancer risks and worries have not (a) assessed comparative risk (i.e., risk for self versus risk for others) or (b) combined perceived breast cancer risk for self (i.e., absolute risk) and perceived breast cancer risk for other women; thus, it is unclear which aspect of worry is related most strongly to which component of absolute risk (6) .3 Consequently, the extent to which worries about breast cancer are related to women’s perceptions about their absolute and comparative risks is an important but understudied issue. Assuming that absolute and comparative risks are related to worry, two additional questions can be addressed: (a) to what extent are breast cancer worries related to perceived absolute risks after accounting for perceptions of comparative risks? and (b) to what extent are breast cancer worries related to comparative risks after accounting for perceptions of absolute risks? We examine these questions in this report.
Understanding the relationship between breast cancer worries and risks may also improve prediction of breast cancer screening by specifying the time frame for the assessment of worry and risk. Is the relationship between breast cancer worries and perceived risks stronger for events framed within the relatively short term (e.g., 10 years) than for events within the long term (lifetime)? Is this relationship similar for absolute and comparative risks? These questions merit attention for at least two reasons. First, medical decisions and health behaviors (e.g., cancer screening) may be affected more powerfully by perceived short-term rather than long-term outcomes (7) . Second, responses to questions using different time frames provide insights into women’s sensitivity to changes in breast cancer risks across time and how changes in risks correspond to changes in perceptions of worry. Because breast cancer risk increases with age, and assuming that perceived breast cancer risks and worries are related, we should expect higher correlations between lifetime risks and worries than when the relationship is assessed for other time points. Indeed, correlations between risks and worries may be higher when framed within the context of a person’s lifetime than any other time point. We also examined this issue.
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Materials and Methods |
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TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
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A total of 2388 women were contacted. Thirty-five percent of the women contacted were ineligible (n = 844; women were either the wrong age or refused materials), and 25% (n = 602) were not reached during the recruitment period (September 21, 1998 through February 25, 1999). Of the remaining 942 women, 581 women (62%) agreed to participate. The mean age was 49.5 years (SD, 2.4 years), 75% were Caucasian, 75% had some college or greater, 75% were married, and 91% had enough income to pay the bills.
Measures
Absolute Risk.
Perceptions of absolute risk were assessed using verbal and numerical
measures within the time span of 10 years and lifetime (a total of four
questions; see Ref. 8
). The verbal measures asked "How
likely are you to get breast cancer in the next 10 years/in your
lifetime?" Response anchors were: (a) very unlikely;
(b) unlikely; (c) 50–50 chance; (d)
likely; and (e) very likely (scored 1–5, respectively.) For
the numerical measures, women were asked: "On a scale from 0 to 100,
where 0 = certain not to happen, and 100 = certain to happen,
how likely are you to get breast cancer in the next 10 years/in your
lifetime?" Actual 10-year and lifetime breast cancer risk was
assessing using the algorithm of Gail et al.
(9)
.
Comparative Risk.
Women were asked: "Compared to other women your age and race, how
likely are you to get breast cancer in the next 10 years/in your
lifetime?" Anchors were: (a) much below average;
(b) below average; (c) same average risk as other
women your age; (d) above average; and (e) much
above average (scored 1–5, respectively).
Worry about Getting Breast Cancer.
Women were asked: "How worried are you about getting breast cancer in
the next 10 years/in your lifetime?" Anchors were: (a) not
at all worried; (b) slightly worried; (c)
somewhat worried; (d) worried; and (e) very
worried (scored 1–5, respectively).
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Results |
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TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
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Women were somewhat sensitive to the time frame of the risk, as suggested by slight differences in perceptions of their lifetime and 10-year numerical (0–100) absolute risks. Overall, 32%, 61%, and 7% viewed their lifetime risk as greater than, equal to, or less than their 10 year risk, respectively. A similar trend was found for verbal absolute risk (i.e., very unlikely to very likely; data not shown). Perceptions of absolute risk were not affected by whether a woman did or did not have a mammogram.
Perceptions of Comparative Risks.
Women believed, on average, that their 10-year and lifetime
comparative risks (M = 2.5 and M =
2.6 for 10-year and lifetime risk, respectively) were lower than those
of other women their age and race (<3 on the absolute scale, where
3 = same average risk as others). We examined whether this
tendency for women to perceive their risks as lower than those of other
women differed for 10-year and lifetime comparative risks. Overall,
48%, 41%, and 11% perceived their 10-year risks as lower than, the
same as, or greater than those of other women their age and race; 43%,
44%, and 12% perceived their lifetime risks as lower than, the same
as, or greater than those of other women their age and race.
Furthermore, 12%, 84%, and 4% viewed their comparative lifetime
risks as greater than, equal to, or less than their 10-year risk,
respectively. Perceptions of comparative risk were not affected by
whether a woman did or did not have a mammogram.
Correlations among Perceived Risk Indicators.
Perceptions of 10-year and lifetime absolute and comparative risks were
highly correlated (see Table 1
). However, the numerical measures of absolute risk (i.e.,
verbal and numerical) were more highly correlated with each other than
with measures of comparative risks.
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. Overall, the correlations of risk with worry decreased substantially
(31% to 56% relative change) regardless of whether absolute or
comparative risk was partialled.
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Discussion |
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TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
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The latter findings have both theoretical and practical significance. The emotional reaction(s) associated with risk probabilities may mediate the relationship between risk perceptions and decision-making outcomes and behaviors. If so, the relations between breast cancer risk perceptions (a cognitive element) and emotions (e.g., fear, worry, and anxiety) about getting breast cancer and how these pathways affect decision-making processes and behaviors should be further investigated. Our findings suggest, at least with respect to the relationship between risks and worries, that future studies should assess both absolute and comparative risk perceptions. From a practical perspective, if the intent is to encourage breast cancer screening via emotional appeals, such as increasing breast cancer worry by using risk information, careful consideration should be given as to how best to combine information about absolute and comparative risks. For example, if the motivation to screen for breast cancer is based initially on a sequential assessment of risk beginning with comparative and then absolute risk (7) , creating communications that heighten perceptions of risk on both these risk dimensions may be needed to evoke sufficient worry to initiate the behavior change. Conversely, it is also possible that the intensity of worry derived from such communications may pose barriers to screening. In essence, whether the intensity of worry motivates behavior change (e.g., screening), may be based, in part, on the differential magnitudes of perceived absolute and comparative risks.
There are several caveats about our results. First, they are most generalizable to primarily white, well-educated, married women. Second, these results are cross-sectional, thereby limiting our ability to make causal statements. Third, we used single questionnaire items to assess magnitude of worry. This departs from other studies that have formed composite measures of worry based on three to four items (10, 11, 12) . Nonetheless, it is comforting that the use of a single item closely replicated the magnitude of the associations between risks and worries found in other studies (5) .3 This study should be regarded as a preliminary step in clarifying the relationships between breast cancer worries and perceived absolute and comparative risks using different time frames.
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Acknowledgments |
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Footnotes |
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1 Supported by the National Cancer Institute Grant
5U19CA72099-04. 
2 To whom requests for reprints should be
addressed, at Duke University Medical Center, 905 West Main Street, Box
34, South Building, Durham, NC 27701. E-mail: Lipku001{at}mc.duke.edu
3 A possible exception to the general statement
that breast cancer worries and comparative risks have not been examined
together is the study by McCaul and O’Donnell (5)
. They
assessed the relationship between absolute and comparative risks with
the intrusion subscale of the Revised Impact of Events Scale
(13)
as a measure of breast cancer worry. Both risk
estimates were related to more intrusive thoughts (rs = 0.34 and
0.38 for the absolute and comparative risk measures, respectively,
ps < 0.01). For purposes of this study, it is questionable
whether the Revised Impact of Events Scale should be considered a
direct measure of the magnitude of breast cancer worries rather than a
general measure of psychological distress.
4 We assessed partial correlations among the
verbal anchors rather than verbal and numerical anchored responses to
keep the scaling of the outcomes (i.e., verbal)
consistent.
Received 12/30/99; revised 6/ 6/00; accepted 6/15/00.
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