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Survey Finds Perceived Risk of Recurrence is Low in African American Breast Cancer Survivors
(PHILADELPHIA, Feb 2007) − A unique survey of African American breast
cancer survivors at heightened risk for hereditary breast cancer has
found the majority do not believe they have an increased chance of
developing the cancer again.
Researchers from the University of Pennsylvania, reporting in the
February issue of Cancer Epidemiology, Biomarkers & Prevention, say
these findings suggest it is important to ensure that African American
women understand their risk of developing cancer and genetic counseling
to address cultural beliefs and values may be one way of doing so.
“Having a personal and family history of breast cancer are known risk
factors for breast cancer, and it is surprising and worrisome that most
of these women with such a history don’t recognize that risk,” said the
study’s lead author, Chanita Hughes Halbert, Ph.D., assistant professor
of psychiatry and Director of the Community and Minority Cancer Control
Program at the University of Pennsylvania’s Abramson Cancer Center.
Halbert’s research focuses on understanding the socio-cultural
underpinnings of cancer prevention and control behaviors among
ethnically diverse populations so that interventions can be designed
that reduce cancer morbidity and mortality.
One such intervention is genetic counseling that often includes testing
whether a woman has a mutation in one of two genes (BRCA1/BRCA2); women
with these genes are at greater risk for developing breast cancer than
women without alterations in those genes.
In an earlier study, Halbert found that African American women with a
family history of breast cancer had a lower risk perception than did
Caucasian breast cancer survivors. In this study, she and a team of
researchers at Penn attempted to tease apart the factors that might lead
to this disparity, one of which, they believe, is the way survivors
think about time.
“Attitudes about time are aspects of a cultural worldview,” Halbert
said. “We thought, based on earlier work, that African American women
who were most concerned about things that might happen in the future
would have a heightened perception of risk.”
The researchers surveyed 95 African-American women who had a personal
and family history of breast cancer that was suggestive of hereditary
disease, had been treated for the disease with either lumpectomy or
mastectomy, and had one intact breast. All of the women were offered the
opportunity to participate in genetic counseling.
The researchers found that 53 percent of respondents felt they had the
same or a lower risk of developing breast cancer again compared to other
women, but that a substantial minority of the survivors (47 percent)
reported that they had a higher or much higher risk.
Investigators found support for one of their hypotheses -- that women
with more education were significantly more likely to perceive a higher
risk of breast cancer recurrence.
But their hypothesis about time perception was wrong. Instead,
perception of risk was related to how often a woman thought about the
past. Women who thought more about the past were about three times more
likely to report that they had a high risk of developing breast cancer
That finding makes sense, Halbert said, if respondents have a continued
sense of vulnerability. “Because past experiences with disease may still
be salient to women who think about the past a lot, these women may be
likely to believe that they have a high risk of developing breast cancer
again,” she said.
The findings suggest that during genetic counseling, more focus should
be placed on providing cancer risk information and in understanding the
basis of risk perceptions, especially how they may be related to past
experiences with disease, Halbert said. “We can enhance genetic
counseling if we develop a better understanding of why women believe
they may be at higher or lower risk,” she said.
study was funded by a grant from the Department of Defense.
Source: American Association
for Cancer Research
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