Cancer Risk Awareness and Concern among Women with a Family History of Breast or Ovarian Cancer

Development and psychometric evaluation of the death risk perception scale for advanced cancer patients

BACKGROUND

An accurate perception of death risk is a prerequisite for advanced cancer patients to make informed end-of-life care decisions. However, there is to date no suitable scale to measure death risk perception. This study was to develop and psychometrically test the death risk perception scale (DRPS) for advanced cancer patients.

METHODS

Process of instrument development and psychometric evaluation were used. First, qualitative research, a literature review, brainstorming, a Delphi study, and cognitive interviews were conducted to construct a pretest scale of death risk perception. Second, a scale-based survey was administered to 479 advanced cancer patients. Item, exploratory factor, and confirmatory factor analyses were employed to optimize the scale. The Cronbach's alpha was calculated as a reliability analysis. The validity analysis included construct, convergent, discriminant, and content validity values.

RESULTS

A three-dimension, 12-item scale was developed, including deliberative, affective, and experiential risk perception. The confirmatory factor analysis supported the three-factor model with satisfactory convergent and discriminant validity levels. The Cronbach's alpha coefficient for internal consistency was 0.807 and scale-level content validity index was 0.98.

CONCLUSIONS

The 12-item DRPS is a reliable and valid instrument for assessing the level of death risk perception in advanced cancer patients. More studies are needed to examine its structure and robustness prior to use.

Knowledge About Gastrointestinal Cancers in People Referred for Endoscopy and Colonoscopy During a Screening Program: a Cross-sectional Study in Guilan, North of Iran

PURPOSE

The most northern and northwestern regions of Iran are at a high risk for gastrointestinal cancers. In this study, we evaluated knowledge of gastrointestinal (GI) cancers in people referred for endoscopy and colonoscopy screening.

METHODS

This cross-sectional study was carried out among 461 people who were under the patronage of a local relief foundation and referred for endoscopy and colonoscopy to the Gastrointestinal and Liver Disease Research Center (GLDRC), Rasht, north of Iran, from March 2016 to March 2017. A well-defined two-sectioned questionnaire was carried out for each group.

RESULTS

Overall, 300 and 161 individuals were in the gastric and colon cancer knowledge group, respectively. The level of knowledge in various areas of gastric and colon cancer was desirable. In general, the average of different domains in gastric and colon cancer knowledge questions were 20.2 ± 6.6 and 19.2 ± 4.9, with the knowledge level higher than the mean in gastric cancer (58%) and colon cancer (67.1%). The mean score of knowledge of GI cancers in terms of risk factor indicated a significant relationship between BMI and alcohol consumption. Meanwhile, a meaningful relationship between symptoms and BMI with knowledge was declared. About domains of colon cancer, there was a significant relationship between younger age and knowledge in the risk factor.

CONCLUSIONS

The results of this study can provide an opportunity to formulate strategies to achieve goals, especially in the field of education, prevention, and control of the disease by raising knowledge for the general public and educating people who are responsible for providing and delivering health services to this community.

Literacy of Breast Cancer and Screening Guideline in an Immigrant Group: Importance of Health Accessibility

Little is known about predictors of breast cancer literacy among immigrant women. A cross-sectional survey investigated predisposing, enabling, and need factors of breast cancer literacy among 233 Korean American women living in a southeastern U.S. city. Breast cancer literacy was measured by questions that asked awareness of cancer screening methods and a 5-item questionnaire derived from the American Cancer Society's breast cancer screening guidelines and risk factors. Annual checkup was an enabling factor of awareness of Clinical Breast Exam (CBE) and mammogram, and also for breast cancer literacy covering the knowledge of breast cancer screening guidelines and risk factors. Health status was a need factor of CBE awareness. Marital status was a predisposing factor of mammogram awareness, and age and years of residence in the US were predisposing factors of breast cancer literacy. The findings of the study illuminate probable avenues of intervention to promote breast health knowledge for Korean American women.

Nursing Students' Awareness about the Warning Signs of Cancer

Objective:

Nursing students who take care of the patient in clinical area practices as a part of their internships in primary health care and clinical areas, should be aware of the warning signs of cancer so that they may inform the community about them.

Methods:

This study was conducted to determine the awareness of nursing students about the warning signs of cancer. The research was planned as a descriptive and cross-sectional study. The research was completed with 460 nursing students between February 2019 and May 2019.

Results:

The average age of the students participating in the study was 20.05 ± 2.04 years. Female nursing students were more familiar with the warning signs of cancer, than male nursing students. Second, third- and fourth-grade nursing students knew the warning sign of better than the first graders. More nursing students who had taken the internal diseases nursing course knew the warning sign of better compared to the students who did not take the course. Nursing students with a family member with a history of cancer knew the warning better than those who did not have a family history of cancer. Thickening or lump in the breast or elsewhere” was the most known warning sign of cancer (92.6%), whereas the least known sign was “indigestion or difficulty in swallowing” (47.0%).

Conclusions:

Female nursing students those who had taken the internal diseases nursing course and those who had a family member with a history of cancer were more aware of the warning signs of cancer.

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

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.

What do people think about genetics? A systematic review

Genetics is increasingly becoming a part of modern medical practice. How people think about genetics' use in medicine and their daily lives is therefore essential. Earlier studies indicated mixed attitudes about genetics. However, this might be changing. Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) as a guideline, we initially reviewed 442 articles that looked at awareness, attitudes, knowledge, and perception of risks among the general and targeted recruitment populations. After fitting our criteria (from the last 5 years, conducted in the USA, non-provider populations, quantitative results reported, and assessed participants 18 years and older), finally 51 eligible articles were thematically coded and presented in this paper. Awareness is reported as relatively high in the studies reviewed. Attitudes are mixed but with higher proportions reporting positive attitudes towards genetic testing and counseling. Self-reported knowledge is reasonably high, specifically with the effects of specific programs developed to raise knowledge levels of the general and targeted recruited populations. Perception of risk is somewhat aligned with actual risk. With the reasonable positive reports of genetic awareness and knowledge, there is similar positive attitude and perception of risk, supporting the need for continued dissemination of such knowledge. Given interest in incorporating community participation in genomic educational strategies, we provide this review as a baseline from which to launch community-specific educational supports and tools.

Women with Family History of Breast Cancer: How Much Are They Aware of Their Risk?

The aims of this study are to assess knowledge of inheritance characteristics of breast cancer and risk reduction strategies and to determine risk perception and the factors affecting risk perception of women with family history. There is a gap in our understanding of risk perception and knowledge of genetic aspect of breast cancer and risk reduction strategies in women with a family history of breast cancer. The study design is descriptive cross-sectional study. Between January 2015 and 2016 at a training and research hospital in Turkey, 117 women who were the first- and second-degree relatives of breast cancer patients were included in the study. Perceived risk scale, cancer worry chart, and a knowledge assessment form were used to collect data. Of the women, 34.1% were first-degree relatives of a breast cancer patient, and knowledge score was 6.9 ± 2.19 out of 11. Almost half of the women (41.9%) moderately worry about the chances of getting breast cancer, and half of the women (51.3%) ranked their perceived risk as moderate (26-50% out of 100%). There is a significant difference between the perceived risk and educational level, having genetic testing, and a significant relationship between the perceived risk and worry level of women. However, breast cancer screening behavior was not affected by risk perception. The knowledge of women regarding inheritance characteristics of breast cancer and risk reduction strategies was moderate, but still majority of women have moderate or higher level of risk perception and are worried about getting breast cancer. Therefore, interventions should be planned to reduce worry and to increase risk reduction strategies such as screening and other health behaviors in women at risk for breast-ovarian cancer.

Perceptions of Cancer Risk, Cause, and Needs in Participants from Low Socioeconomic Background at Risk for Hereditary Cancer

The purpose of this study was to describe perceptions of cancer risk, cause, and needs in participants from a low socioeconomic background at risk for hereditary cancer. We surveyed 307 individuals with the Cancer Awareness and Needs survey and received 128 responses (41.6% response rate). Family history, genetics, and tobacco use were selected most frequently as a cause of cancer; 36% (n = 46) selected fate and/or God's will. A total of 87.5% (n = 112) understood that having a close family member with breast cancer could increase personal risk; however responses were varied when asked if this was related to risk for other cancers. Most participants had undergone cancer screening, half reported undergoing breast magnetic resonance imaging, which was associated with personal (p < 0.01) and family cancer history (p = 0.03). An additional 76.6% (n = 98) felt informed about cancer screening and most received information from health care providers and family or friends. Ensuring that patients and clinicians are educated about hereditary cancer risk, detection, and prevention should be priorities for future research.

The effect of referral for genetic counseling on genetic testing and surgical prevention in women at high risk for ovarian cancer: Results from a randomized controlled trial

BACKGROUND

Guidelines recommend genetic counseling and testing for women who have a pedigree suggestive of an inherited susceptibility for ovarian cancer. The authors evaluated the effect of referral to genetic counseling on genetic testing and prophylactic oophorectomy in a randomized controlled trial.

METHODS

Data from an electronic mammography reporting system identified 12,919 women with a pedigree that included breast cancer, of whom 625 were identified who had a high risk for inherited susceptibility to ovarian cancer using a risk-assessment questionnaire. Of these, 458 women provided informed consent and were randomized 1:1 to intervention consisting of a genetic counseling referral (n = 228) or standard clinical care (n = 230).

RESULTS

Participants were predominantly aged 45 to 65 years, and 30% and 20% reported a personal history of breast cancer or a family history of ovarian cancer, respectively. Eighty-five percent of women in the intervention group participated in a genetic counseling session. Genetic testing was reported by 74 (33%) and 20 (9%) women in the intervention and control arms (P < .005), respectively. Five women in the intervention arm and 2 in the control arm were identified as germline mutation carriers. Ten women in the intervention arm and 3 in the control arm underwent prophylactic bilateral salpingo-oophorectomy (P < .05).

CONCLUSIONS

Routine referral of women at high risk for ovarian cancer to genetic counseling promotes genetic testing and prophylactic surgery. The findings from the current randomized controlled trial demonstrate the value of implementing strategies that target women at high risk for ovarian cancer to ensure they are offered access to recommended care. CA Cancer J Clin 2016. © 2016 American Cancer Society, Inc. Cancer 2016;122:3509-3518. © 2016 American Cancer Society.