scholarly journals Accuracy of self-perceived risk perception of breast cancer development in Iranian women

2020 ◽  
Author(s):  
Karimollah Hajian-Tilaki ◽  
Maryam Nikpour
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Risk Perception ◽  
High Risk ◽  
Perceived Risk ◽  
The Self ◽  
Lifetime Risk ◽  
Average Risk ◽  
Actual Risk ◽  
Subjective Risk

Abstract Backgrand: The accuracy of subjective risk perception is a matter of concern in breast cancer development. The objective of this study was to evaluate the accuracy of self-perceived risk assessment compared to actual risk. Methods: The demographic, clinical, and reproductive characteristics of 800 women aged 35-85 years were collected with an in-person interview. The self-perceived risk was assessed using the visual analog scale (VAS) and the actual risk was calculated from the Gail model. Gail’s cutoff of 1.66% risk was used to categorize the estimated 5-year actual risk as low/average risk (<1.66%) and high risk (≥1.66). In low/average risk, if the self-perceived risk> actual risk, then individuals were categorized as overestimating. Similarly, in high-risk women, if the perceived risk<actual risk, then, the subjects were labeled as under-estimate; otherwise, it was labeled as accurate. The Kappa statistics were used to determine the agreement between self-perceived risk and actual risk. ROC analysis was applied to determine the accuracy of self-perceived risk in the prediction of actual risk. Results: The perceived risk was significantly higher than actual risk (p=0.001, 0.01 for 5-year and lifetime risk respectively). Both in low and high-risk groups about half of the women over-estimate and underestimate the risk by subjective risk perception. For a 5-year risk assessment, there was no agreement at all between perceived risk and actual risk (Kappa=0.00, p=0.98) but a very low agreement between them in lifetime risk assessment (Kappa=0.09, p=0.005). The performance of accuracy of risk perception versus actual risk was very low (AUC=0.53, 95%CI: 0.44-0.61 and AUC=0.58, 95%CI: 0.54-0.62 for the 5- year risk and lifetime risk respectively). Conclusion: The clinical performance of risk perception based on VAS is very poor. Thus, the efforts of the public health education program should focus on the correct perception of breast cancer risk among Iranian women.

scholarly journals Accuracy of Self-Perceived Risk Perception of Breast Cancer Development in Iranian Women

2020 ◽  
Author(s):  
Karimollah Hajian-Tilaki ◽  
Maryam Nikpour
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Risk Perception ◽  
High Risk ◽  
Perceived Risk ◽  
The Self ◽  
Lifetime Risk ◽  
Average Risk ◽  
Actual Risk ◽  
Subjective Risk

Abstract Backgrand: The accuracy of subjective risk perception is a matter of concern in breast cancer development. The objective of this study was to evaluate the accuracy of self-perceived risk assessment compared to actual risk. Methods: The demographic, clinical, and reproductive characteristics of 800 women aged 35-85 years were collected with an in-person interview. The self-perceived risk was assessed using the visual analog scale (VAS) and the actual risk was calculated from the Gail model. Gail’s cutoff of 1.66% risk was used to categorize the estimated 5-year actual risk as low/average risk (<1.66%) and high risk (≥1.66). In low/average risk, if the self-perceived risk> actual risk, then individuals were categorized as overestimating. Similarly, in high-risk women, if the perceived risk<actual risk, then, the subjects were labeled as under-estimate; otherwise, it was labeled as accurate. The Kappa statistics were used to determine the agreement between self-perceived risk and actual risk. ROC analysis was applied to determine the accuracy of self-perceived risk in the prediction of actual risk. Results: The perceived risk was significantly higher than actual risk (p=0.001, 0.01 for 5-year and lifetime risk respectively). Both in low and high-risk groups about half of the women over-estimate and underestimate the risk by subjective risk perception. For a 5-year risk assessment, there was no agreement at all between perceived risk and actual risk (Kappa=0.00, p=0.98) but a very low agreement between them in lifetime risk assessment (Kappa=0.09, p=0.005). The performance of accuracy of risk perception versus actual risk was very low (AUC=0.53, 95%CI: 0.44-0.61 and AUC=0.58, 95%CI: 0.54-0.62 for the 5- year risk and lifetime risk respectively). Conclusion: The clinical performance of risk perception based on VAS is very poor. Thus, the efforts of the public health education program should focus on the correct perception of breast cancer risk among Iranian women.

scholarly journals Accuracy of self-perceived risk perception of breast cancer development in Iranian women

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Karimollah Hajian-Tilaki ◽  
Maryam Nikpour
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Risk Perception ◽  
High Risk ◽  
Perceived Risk ◽  
Lifetime Risk ◽  
Cancer Development ◽  
Iranian Women ◽  
Breast Cancer Development ◽  
Actual Risk

Abstract Background The accuracy of subjective risk perception is a matter of concern in breast cancer development. The objective of this study was to evaluate the accuracy of self-perceived risk assessment of breast cancer development and compared to actual risk in Iranian women. Methods The demographic, clinical, and reproductive characteristics of 800 women aged 35–85 years were collected with an in-person interview. The self-perceived risk and the actual risk were assessed using the visual analog scale (VAS) and he Gail model respectively. Gail’s cutoff of 1.66% risk was used to categorize the estimated 5-year actual risk as low/average risk (< 1.66%) and high risk (≥ 1.66). In low/average risk, if the self-perceived risk > actual risk, then individuals were considered as overestimating. Similarly, in high-risk women, if the perceived risk < actual risk, then, the subjects were labeled as under-estimate; otherwise, it was labeled as accurate. The Kappa statistics were used to determine the agreement between self-perceived risk and actual risk. ROC analysis was applied to determine the accuracy of self-perceived risk in the prediction of actual risk. Results The perceived risk was significantly higher than actual risk (p = 0.001, 0.01 for 5-year and lifetime risk respectively). Both in low and high-risk groups about half of the women over-estimate and underestimate the risk by subjective risk perception. For a 5-year risk assessment, there was no agreement between perceived risk and actual risk (Kappa = 0.00, p = 0.98) but a very low agreement between them in lifetime risk assessment (Kappa = 0.09, p = 0.005). The performance of accuracy of risk perception versus actual risk was very low (AUC = 0.53, 95% CI 0.44–0.61 and AUC = 0.58, 95% CI 0.54–0.62 for the 5-year risk and lifetime risk respectively). Conclusion The clinical performance of risk perception based on VAS is very poor. Thus, the efforts of the public health education program should focus on the correct perception of breast cancer risk among Iranian women.

Implementation of a High-Risk Breast Clinic for Comprehensive Care of Women With Elevated Breast Cancer Risk Identified by Risk Assessment Models in the Community

2020 ◽  
pp. OP.20.00256
Author(s):  
Alison Laws ◽  
Therese M. Mulvey
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Genetic Testing ◽  
High Risk ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Lifetime Risk ◽  
Comprehensive Care ◽  
Breast Clinic ◽  
High Risk Breast

INTRODUCTION: Many radiology centers perform risk assessment at time of screening mammography. The Massachusetts General Hospital North Shore Cancer Center (MGHNS) developed a nurse practitioner (NP)–led high-risk breast clinic (HRBC) to provide comprehensive care for patients with elevated breast cancer risk by a validated tool. PATIENTS AND METHODS: Patient and administrative data from the MGHNS HRBC was collected to evaluate clinical and implementation outcomes. We compared patients from the HRBC with those identified as having ≥ 20% lifetime risk at 5 community imaging centers. RESULTS: From March 2018 to February 2019, 318 patients were seen in the HRBC; 264 (83%) had ≥ 20% lifetime risk, 13 (4%) had prior atypia/lobular carcinoma in situ, 9 (3%) had ≥ 1.7% 5-year risk, and 32 (10%) had no indication of elevated risk. Genetic testing was recommended for 159 patients (50%); 33 (21%) completed testing with 1 mutation identified. Chemoprevention was discussed with 99 patients (31%); 9 (9%) initiated treatment. Screening magnetic resonance imaging (MRI) was recommended for 284 patients (89%); 184 (65%) had MRI performed with 2 mammographically occult cancers identified. During this time period, 215,112 patients had risk assessment performed at time of breast imaging; of these, 1,170 were found to have ≥ 20% lifetime risk. Compared with those identified as high risk in the community, patients seen in the HRBC were more likely to be white (94.3% v 85.4%; P < .001) and have a family history of ovarian cancer (16.4% v 9.4%; P < .001). CONCLUSION: We demonstrate the feasibility of an NP-led HRBC. Follow-through of recommendations by patients was highest for screening MRI; use of genetic testing and chemoprevention was lower than anticipated. In our community, uptake of the HRBC by referring providers remains a barrier, with only a minority of identified high-risk patients assessed in our clinic.

scholarly journals Comparative risk assessment for the development of cardiovascular diseases in the Hungarian general and Roma population

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peter Piko ◽  
Zsigmond Kosa ◽  
Janos Sandor ◽  
Roza Adany
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Average Risk ◽  
Cvd Risk ◽  
Roma Population

AbstractCardiovascular diseases (CVDs) are the number one cause of death globally, and the early identification of high risk is crucial to prevent the disease and to reduce healthcare costs. Short life expectancy and increased mortality among the Roma are generally accepted (although not indeed proven by mortality analyses) which can be partially explained by the high prevalence of cardiovascular risk factors (CVRF) among them. This study aims to elaborate on the prevalence of the most important CVD risk factors, assess the estimation of a 10-year risk of development of fatal and nonfatal CVDs based on the most used risk assessment scoring models, and to compare the Hungarian general (HG) and Roma (HR) populations. In 2018 a complex health survey was accomplished on the HG (n = 380) and HR (n = 347) populations. The prevalence of CVRS was defined and 10-year cardiovascular risk was estimated for both study populations using the following systems: Framingham Risk Score for hard coronary heart disease (FRSCHD) and for cardiovascular disease (FRSCVD), Systematic COronary Risk Evaluation (SCORE), ACC/AHA Pooled Cohort Equations (PCE) and Revised Pooled Cohort Equations (RPCE). After the risk scores had been calculated, the populations were divided into risk categories and all subjects were classified. For all CVD risk estimation scores, the average of the estimated risk was higher among Roma compared to the HG independently of the gender. The proportion of high-risk group in the Hungarian Roma males population was on average 1.5–3 times higher than in the general one. Among Roma females, the average risk value was higher than in the HG one. The proportion of high-risk group in the Hungarian Roma females population was on average 2–3 times higher compared to the distribution of females in the general population. Our results show that both genders in the Hungarian Roma population have a significantly higher risk for a 10-year development of cardiovascular diseases and dying from them compared to the HG one. Therefore, cardiovascular interventions should be focusing not only on reducing smoking among Roma but on improving health literacy and service provision regarding prevention, early recognition, and treatment of lipid disorders and diabetes among them.

Global tissue stiffness on breast MR elastography: High-risk dense breast patients have higher stiffness compared to average-risk dense breast patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10541-10541
Author(s):  
Bhavika K. Patel ◽  
Kay Pepin ◽  
Kathy R Brandt ◽  
Gina L. Mazza ◽  
Barbara A. Pockaj ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Risk ◽  
Menopausal Status ◽  
Risk Groups ◽  
Average Risk ◽  
Tissue Stiffness ◽  
Tissue Properties ◽  
Dense Breasts ◽  
Risk Patients

10541 Background: Biomechanical tissue properties may vary in the breasts of patients at elevated risk for breast cancer. We aim to quantify in vivo biomechanical tissue properties in various breast densities and in both normal risk and high risk women using Magnetic Resonance Imaging (MRI)/MRE and examine the association of biomechanical properties of the breast with cancer risk. Methods: In this IRB–approved prospective single-institution study, we recruited two groups of women differing by breast cancer risk to undergo a 3.0 T dynamic contrast enhanced MRI/MRE of the breast. Low-average risk women were defined as having no personal or significant family history of breast cancer, no prior high risk breast biopsies and a negative mammography within 12 months. High-risk breast cancer patients were recruited from those patients who underwent standard of care breast MR. Within each breast density group (non-dense versus dense), two-sample t-tests were used to compare breast stiffness, elasticity, and viscosity across risk groups (low-average vs high). Results: There were 50 low-average risk and 86 high-risk patients recruited to the study. The risk groups were similar on age (mean age = 55.6 and 53.6 years), density (68% vs. 64% dense breasts) and menopausal status (66.0% vs. 69.8%). Among patients with dense breasts, mean stiffness, elasticity, and viscosity were significantly higher in high risk patients ( N = 55) compared to low-average risk patients ( N = 34; all p < 0.001). In the multivariate logistic regression model, breast stiffness remained a significant predictor of risk status (OR=4.26, 95% CI [1.96, 9.25]) even after controlling for breast density, MRI BPE, age, and menopausal status. Similar results were seen for breast elasticity (OR=4.88, 95% CI [2.08, 11.43]) and viscosity (OR=11.49, 95% CI [1.15, 114.89]). Conclusions: Structurally-based, quantitative biomarker of tissue stiffness obtained from global 3D breast MRE is associated with differences in breast cancer risk in dense breasts. As such, tissue stiffness could provide a novel prognostic marker to help identify the subset of high-risk women with dense breasts who would benefit from increased surveillance.[Table: see text]

Predicting reattendance at a high-risk breast cancer clinic

2015 ◽  
Vol 13 (5) ◽  
pp. 1441-1448 ◽  
Author(s):  
Sarah R. Ormseth ◽  
David K. Wellisch ◽  
Adam E. Aréchiga ◽  
Taylor L. Draper
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Perceived Risk ◽  
Depressive Symptomatology ◽  
High Risk Breast Cancer ◽  
High Risk Breast ◽  
Risk Breast Cancer ◽  
Cancer Clinic ◽  
High Risk Clinic

AbstractObjective:The research about follow-up patterns of women attending high-risk breast-cancer clinics is sparse. This study sought to profile daughters of breast-cancer patients who are likely to return versus those unlikely to return for follow-up care in a high-risk clinic.Method:Our investigation included 131 patients attending the UCLA Revlon Breast Center High Risk Clinic. Predictor variables included age, computed breast-cancer risk, participants' perceived personal risk, clinically significant depressive symptomatology (CES–D score ≥ 16), current level of anxiety (State–Trait Anxiety Inventory), and survival status of participants' mothers (survived or passed away from breast cancer).Results:A greater likelihood of reattendance was associated with older age (adjusted odds ratio [AOR] = 1.07, p = 0.004), computed breast-cancer risk (AOR = 1.10, p = 0.017), absence of depressive symptomatology (AOR = 0.25, p = 0.009), past psychiatric diagnosis (AOR = 3.14, p = 0.029), and maternal loss to breast cancer (AOR = 2.59, p = 0.034). Also, an interaction was found between mother's survival and perceived risk (p = 0.019), such that reattendance was associated with higher perceived risk among participants whose mothers survived (AOR = 1.04, p = 0.002), but not those whose mothers died (AOR = 0.99, p = 0.685). Furthermore, a nonlinear inverted “U” relationship was observed between state anxiety and reattendance (p = 0.037); participants with moderate anxiety were more likely to reattend than those with low or high anxiety levels.Significance of Results:Demographic, medical, and psychosocial factors were found to be independently associated with reattendance to a high-risk breast-cancer clinic. Explication of the profiles of women who may or may not reattend may serve to inform the development and implementation of interventions to increase the likelihood of follow-up care.

scholarly journals Commentary ACOG Practice Bulletin July 2017: Breast Cancer Risk Assessment and Screening in Average-Risk Women

2018 ◽  
Vol 91 (1090) ◽  
pp. 20170907 ◽  
Author(s):  
Victoria Mango ◽  
Yolanda Bryce ◽  
Elizabeth Anne Morris ◽  
Elisabetta Gianotti ◽  
Katja Pinker
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Cancer Risk Assessment ◽  
Average Risk ◽  
Breast Cancer Risk Assessment

scholarly journals Current and Future Directions of Breast MRI

2021 ◽  
Vol 10 (23) ◽  
pp. 5668
Author(s):  
Margaret Houser ◽  
David Barreto ◽  
Anita Mehta ◽  
Rachel F. Brem
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Digital Breast Tomosynthesis ◽  
Breast Mri ◽  
Preoperative Assessment ◽  
Average Risk ◽  
Dense Breast Tissue ◽  
Increased Risk ◽  
High Risk Populations ◽  
Magnetic Resonance Imaging Mri

Magnetic resonance imaging (MRI) is the most sensitive exam for detecting breast cancer. The American College of Radiology recommends women with 20% or greater lifetime risk of developing breast cancer be screened annually with MRI. However, other high-risk populations would also benefit. Hartmann et al. reported women with atypical hyperplasia have nearly a 30% incidence of breast cancer at 25-year follow-up. Women with dense breast tissue have up to a 4-fold increased risk of breast cancer when compared to average-risk women; their cancers are more likely to be mammographically occult. Because multiple cohorts of women are at high risk for developing breast cancer, there has been a movement to develop an abbreviated MRI (abMRI) protocol to expand the availability of MRI screening. Studies on abMRI effectiveness have been promising, with Weinstein et al. demonstrating a cancer detection rate of 27.4/1000 in women with dense breasts after a negative digital breast tomosynthesis. Breast MRI is also used to evaluate the extent of disease as part of preoperative assessment in women with newly diagnosed breast cancer, and to assess a patient’s response to neoadjuvant chemotherapy. This paper aims to explore the current uses of MRI and propose future indications and directions.

scholarly journals Breast cancer risk assessment: How risk models can “overdiagnose” risk.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 184-184
Author(s):  
Elissa Ozanne ◽  
Brian Drohan ◽  
Kevin S. Hughes
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
High Risk ◽  
Resource Utilization ◽  
Management Strategies ◽  
Cancer Risk Assessment ◽  
Cancer Society ◽  
Total Study Population ◽  
Breast Cancer Risk Assessment ◽  
The Impact

184 Background: Overdiagnosis is commonly defined as a diagnosis of "disease" which will never cause symptoms or death during a patient's lifetime. Similarly, overdiagnosis can also happen when individuals are given the diagnosis of being at risk for a disease, such as being at high-risk for developing breast cancer. Women can be given such a diagnosis by meeting a set of risk assessment criteria, which are often accompanied by recommended management strategies. We sought to identify the extent and consequences of overdiagnosis for individuals being at high risk for breast cancer using the American Cancer Society (ACS) guidelines for the appropriate use of Magnetic Resonance Imaging (MRI). Methods: We identified women who fit the ACS criteria in a population based sample at a community hospital. The ACS criteria mentions three risk assessment models for determining a woman’s risk, and these criteria were reviewed to determine the extent of possible overdiagnosis in this population. The expected resource utilization resulting from this overdiagnosis, and the impact on patient quality of life are extrapolated. Results: 5,894 women who received mammography screening at the study site were included. 342 (5.8%) of the women were diagnosed as high risk by at least one model. However, only 0.2% of the total study population were diagnosed as high risk by all three models. One model identified 330 (5.6%) to be at high risk, while the other two models identified many fewer eligible women (25, 0.4% and 54, 0.9% respectively). Conclusions: Using different models to evaluation the ACS criteria identifies very different populations, implying a large potential for overdiagnosis. Further, this overdiagnosis is likely to result in the outcome of screening too many women, incurring false positives and unnecessary resource utilization.

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