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Does Method of Communication Influence a Woman's Understanding of Familial Breast Cancer Risk?

Maggie L. Shaw
Thirty-seven percent of women prefer to receive their lifetime risk of breast cancer through numbers and words, while 73% prefer a combination of lifetime and 10-year age-related risk.
As part of the BRISC (Breast cancer RIsk Communication study) study out of the Netherlands, investigators sought to determine if method of delivery and personal preference affected how women understood their lifetime risk of breast cancer. Both of these are deemed essential to improving patient-centered care. Their results were published in a recent issue of Patient Preference and Adherence.

“Effective risk communication is a major challenge because many counselees find it difficult to understand the concept of risk,” the study authors stated. “Moreover, the increasing development and use of risk stratification models will make breast cancer risk communication become even more important.”

Their study addressed 3 important questions:
  1. Which risk presentation format do women receiving counseling for familial breast cancer prefer?
  2. Are women’s preferences influenced by the format they received, by their age, or by their education level?
  3. Do women who receive their risk estimates in their preferred format have a better understanding of their risk?
 The 326 women, who were recruited from 3 family cancer clinics in the Netherlands between December 2005 and November 2007, had a family history of breast cancer but had not battled the disease. Their mean (SD) age was 41 (11) years, and 25% were classified as high-risk (30%-40% risk of developing breast cancer).

A counselor presented the risk information to the women following a genetic counseling session. They received this information in 1 of 5 ways:
  1. Percentages (n = 38)
  2. Frequencies (n = 63)
  3. Frequencies plus graphical display (ie, icons) (n = 91)
  4. Frequencies plus 10-year age-related risk (n = 69)
  5. Frequencies and 10-year age-related risk plus graphs (n = 65)
 Two weeks later, the women were asked to fill out a questionnaire. Eighty-six percent (279/326) of the women complied, and they demonstrated a strong grasp of the information they received. These results showed that when receiving their lifetime risk, 37%, the overwhelming majority, preferred to receive their lifetime risk of breast cancer through numbers and words; that when given the choice between percentages and frequencies, 55% chose the former; and that the top choice, at 73%, for time frame was a combination of lifetime and 10-year age-related risk.

In addition, women who were presented with their risk though a graphical display preferred that format. The authors attributed this to figures being “easy to identify with, understandable, and [they] conveyed a meaningful message.” And more older women preferred the 10-year age-related format, which the authors believe is because “the residual risk diminishes with age and thus more specific age-related risks may be preferred by this older age group.”

A notable previous recommendation for how to deliver this information is for counselors to consider how their patients want to receive it, especially because, say the authors, women can estimate their own risk more accurately “when they receive their risk estimates in their preferred format.”

They advise that more studies are needed to investigate the influence of personal preference on understanding and decision-making following receipt of lifetime breast cancer risk.

Reference

Henneman L, van Asperen CJ, Oosterwijk JC, Menko FH, Claassen L, Timmermans DRM. Do preferred risk formats lead to better understanding? a multicenter controlled trial on communicating familial breast cancer risks using different risk formats. Patient Prefer Adherence. 2019;14:333-342. doi: 10.2147/PPA.S232941.

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