How Do Underserved Minority Women Think about Breast Cancer Risk?


The goal of this project is to identify the potential ethical implications of an FQHC clinic-wide policy to provide female patients ages 25-70 with personalized breast cancer risk information. In our partner FQHC, breast cancer risk will be assessed using a computerized tool developed using models that are widely used in clinical practice. The impact of providing personalized breast risk cancer information on patient adherence to recommended screening and risk reduction measures will be evaluated by the parent study.

While it is hypothesized that personalized risk assessment will improve adherence to national screening and prevention guidelines (particularly for those women in higher risk categories), the potential psychosocial harms and benefits of personalized breast cancer risk assessment in this particular population are not fully known. Information about risk perceptions, the value of individualized risk assessment, and preferences regarding recommended surveillance and prevention strategies is also limited.

This supplement will support the collection of data from FQHC patients and primary care physicians (PCP) using qualitative methodologies prior to full implementation of the policy. We will analyze audio recordings of patient-physician conversations about individualized breast cancer risk and conduct in-depth interviews with patients and physicians. Understanding of patient and PCP views on ethical implications of personalized breast cancer risk assessment will inform development of an approach to risk communication that promotes respect for individual patient autonomy and provides appropriate support to patients in all risk strata. Recommendations will be made to refine physician training and patient education materials.

In the context of an FQHC clinic-wide policy to assess breast cancer risk in female patients ages 25-70, this study will pursue the following aims:

  1. Examine patient and primary care physician perspectives on the potential harms [e.g., increased psychological distress] and benefits [e.g., reassurance about breast cancer risk, prevention and early detection] of receiving personalized breast cancer risk information.
  2. Examine patient values and preferences regarding breast cancer risk communication, surveillance, and risk reduction measures.
  3. Explore modifiable factors [e.g., physician communication, comprehension] that influence patient psychological distress in reaction to personalized breast cancer risk information.
  4. Integrate findings to refine physician education and delivery of breast cancer risk information to support informed decision-making, enhance benefits, and reduce risks to patients.

Affiliated Center/Program

Funding Agency

National Cancer Institute of the National Institutes of Health (Grant No. 3P50CA106743-07S2)

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Related publications

Silva A, Rauscher GH, Hoskins K, Rao R, Ferrans CE. Assessing racial/ethnic disparities in chemotherapy treatment among breast cancer patients in context of changing treatment guidelines. Breast Cancer Res Treat. 2013 Dec;142(3):667-72.

Zenk SN, Powell LM, Odoms-Young AM, Krauss R, Fitzgibbon ML, Block D, Campbell RT. Impact of the revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package policy on fruit and vegetable prices. J Acad Nutr Diet. 2013 Oct 30. [See abstract.]

Rauscher GH, Conant EF, Khan JA, Berbaum ML. Mammogram image quality as a potential contributor to disparities in breast cancer stage at diagnosis: an observational study. BMC Cancer. 2013 Apr 26;13:208. [See abstract.]

Rauscher GH, Khan JA, Berbaum ML, Conant EF. Potentially missed detection with screening mammography: does the quality of radiologist's interpretation vary by patient socioeconomic advantage/disadvantage? Ann Epidemiol. 2013 Apr;23(4):210-4. [See abstract.]

Tussing-Humphreys LM, Fitzgibbon ML, Kong A, Odoms-Young A. Weight loss maintenance in African American women: a systematic review of the behavioral lifestyle intervention literature. J Obes. 2013;2013:437369. [See abstract.]

Tejeda S, Darnell JS, Cho YI, Stolley MR, Markossian TW, Calhoun EA. Patient barriers to follow-up care for breast and cervical cancer abnormalities. J Womens Health (Larchmt). 2013;22(6):507-517. [See abstract.]

Anderson EE, Hoskins K. Individual breast cancer risk assessment in underserved populations: integrating empirical bioethics and health disparities research. J Health Care Poor Underserved. 2012 Nov;23(4 Suppl):34-46. [See abstract.]

Rauscher GH, Allgood KL, Whitman S, Conant E. Disparities in screening mammography services by race/ethnicity and health insurance. J Womens Health (Larchmt). 2012 Feb;21(2):154-60.

Freeman VL, Ricardo AC, Campbell RT, Barrett R, Warnecke R. Association of census tract-level socioeconomic status with disparities in prostate cancer-specific survival. Cancer Epidemiol Biomarkers Prev. 2011 Oct;20(10):2150-9. [See abstract.]

Manfredi C, Cho YI, Warnecke R, Saunders S, Sullivan M. Dissemination strategies to improve implementation of the PHS smoking cessation guideline in MCH public health clinics: experimental evaluation results and contextual factors. Health Educ Res. 2011 Apr;26(2):348-60. [See abstract.]

Cho YI, Johnson TP, Barrett RE, Campbell RT, Dolecek TA, Warnecke RB. Neighborhood changes in concentrated immigration and late stage breast cancer diagnosis. J Immigr Minor Health. 2011 Feb;13(1):9-14. [See abstract.]

Kaiser K, Rauscher GH, Jacobs EA, Strenski TA, Ferrans CE, Warnecke RB. The import of trust in regular providers to trust in cancer physicians among white, African American, and Hispanic breast cancer patients. J Gen Intern Med. 2011 Jan;26(1):51-7. [See abstract.]

See the center's publications prior to July 2010.