Acceptance of Referral for Cancer-Risk Counseling in Population of Women Undergoing Breast Biopsy: Variables Predicting Followup at a Cancer Genetics Program.

摘要

This study was designed to demonstrate the utility of brief quantitative risk assessment in breast care clinical settings as a method of referral to cancer risk counseling. We examined factors that influence the decision to undergo cancer risk counseling after the referral is made. We developed a computerized program, BRISK, that calculates interval breast cancer risks using the Gail and Claus epidemiological models, and BRCA1 and BRCA2 mutation probabilities using the Couch, Shattuck-Eidens, Frank, and BRCAPRO models. Questionnaires assessing psychological status, and knowledge and attitudes about breast cancer, cancer risk counseling, and genetic testing were used to identify predictors of referral uptake. Of the 120 subjects in the biopsy setting, 53% had breast cancer risk >- twice the population risk as measured by the epidemiological models. Of the 91 women in the treatment selling, 47% had a BRCA mutation risk >- 10%. Uptake of referral was low in the biopsy group (1/63), but higher in the treatment group (13/43). Predictors of uptake included family history of cancer, interest in family risks, high income, psychological disturbance, and perceived risk. Barriers included lack of time, cost, and fear of insurance discrimination. However, 81% thought brief risk assessment should be routine, suggesting annual mammography or OB/GYN visits as the most effective selling. Brief breast cancer risk assessment is easily incorporated into clinical settings and is well-accepted by most patients. It can be utilized not only for management of individuals, but also for public health intervention, resource allocation, and targeted research.