Breast Cancer Prevention: The Views of Women and Physicians

Institution: University of California, San Francisco
Investigator(s): Celia Kaplan, Dr.P.H. - Celia Kaplan, Dr.P.H. - Celia Kaplan, Dr.P.H. -
Award Cycle: 2000 (Cycle VI) Grant #: 6PB-0053 Award: $434,559
Award Type: Request for Applications
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

Initial Award Abstract (2000)
Breast cancer is a leading women’s health concern in the U. S., where over 180,000 new cases are diagnosed yearly. New research has led to a greater knowledge of genetic predisposition and understanding of how lifestyle behaviors are related to risk of breast cancer. Despite these advances, the medical community has been unable to establish clear-cut guidelines for women to assess their risk and there is a lack of consensus as to the most appropriate and effective ways to "prevent" breast cancer, i.e., to reduce risk, based on current knowledge. Due to the lack of guidelines and the controversy within the breast cancer prevention field, physicians play a critical role and have a greater responsibility in providing up-to-date information to their patients. Little is known about how doctors advise their patients about breast cancer risk or the factors affecting these practices.

This study proposes to examine the knowledge, attitudes and practices of women and physicians with regard to breast cancer prevention. We will conduct a telephone survey of 1200 women, from four ethnic groups, at varying risk of breast cancer. Participants will be recruited from the San Francisco Mammography Registry (SFMR). Women will be eligible for the study if they are between 40 and 75 years of age, have no prior history of breast cancer, and are English, Spanish, or Cantonese speaking. This survey will examine women’s perceived risk for breast cancer, knowledge of risk assessment tools and available options for the primary prevention of breast cancer. We will also survey 1000 randomly selected physicians from 3 different specialties (general internal medicine, family medicine, and obstetrics/gynecology ) practicing in the Bay Area. This survey will examine physician knowledge of breast cancer prevention and beliefs about the effectiveness of current therapies. We will also examine physicians' current practices, attitudes, and the perceived obstacles related to breast cancer prevention. In addition, this information will be utilized to determine if there are any differences among physicians based on the type of practice, gender, or the geographic location of their medical practice.

The growing therapeutic options for the primary prevention of breast cancer make this an opportune time to study how women assess their risk of breast cancer, acquire information about new options and make decisions about their use. Knowledge gained from this study will facilitate the development and evaluation of physicians’ and patients’ interventions targeted to improve patient-doctor decision-making with respect to breast cancer prevention. The ultimate goal is to ensure that all women, regardless of their ethnic/racial group, receive from their doctors the most up-to-date and reliable medical information available so that they may make the most informed choices possible regarding their health.

Final Report (2005)
New developments and technologies in the field of breast cancer risk reduction and prevention are being incorporated into clinical practice, yet relatively little is known about the extent of their acceptance and use by women patients and by physicians. This study was undertaken to learn about the knowledge, attitudes and practices of both women and physicians with regard to breast cancer risk reduction.

For the women's arm of the study, we identified more than 13,000 eligible women through the San Francisco Mammography Registry, all of whom were Asian/Pacific Islander (API), African-American (Black), Latina, or White, 40 to 75 years old, and had no personal history of breast cancer. We randomly selected 2800 women for our sample. Contact mailings were sent and telephone interviews conducted from March 2002 to July 2003. A total of 1700 completed surveys were obtained (63% response rate). The study measured whether respondents had ever heard of, discussed with a doctor, or used any of four therapies for breast cancer risk reduction: tamoxifen, raloxifene, genetic testing, and preventive surgery (mastectomy or oophorectomy).

About 40% of participants were White, 20% API, 20% Black, and 20% Latina. The mean age was 54 years old. Close to one-third of the sample (32%) was at high risk for breast cancer. Most women had some college or more and some form of health insurance. Fifty-four percent of women had heard of tamoxifen whereas only 4% had discussed or used it; similar results were seen for raloxifene (27% versus 4%), genetic testing and counseling (40% versus 4%), and preventive surgery (69% versus 5%). Most Whites (94%) had heard of at least one therapy, followed by Blacks (80%), Latinas (65%), and APIs (62%).

For the physicians' arm of the study, we identified 1647 eligible physicians through the AMA Masterfile, all of whom practiced in California and specialized in family medicine, internal medicine, or obstetrics/gynecology. Through a self-administered mail questionnaire, physicians reported their breast cancer risk reduction practices (initiating patient counseling, referring patients for genetic evaluation, and prescribing tamoxifen or raloxifene) as well as barriers to counseling. Mailings were sent between January and April, 2002. A total of 822 completed questionnaires were obtained (50% response rate).

Respondents' specialties were 33% family medicine, 28% internal medicine, and 39% obstetrics/ gynecology. The majority of physicians were white (57%), male (58%), and worked in a private setting (67%). Most reported initiating counseling (86%), whereas 45% referred a patient for genetic evaluation, 31% prescribed raloxifene, and 11% prescribed tamoxifen. The leading frequent barriers to counseling were "not enough time" (40%) and "not sufficiently informed about risk reduction options" (19%).

Findings from this study will facilitate the development and evaluation of interventions for improving patient-physician communication and informed decision-making about breast cancer risk reduction.

Factors affecting breast cancer risk reduction practices among California physicians.
Periodical:Preventive Medicine
Index Medicus: Prev Med
Authors: Kaplan CP, Haas JS, Pérez-Stable EJ, Des Jarlais G, Gregorich SE.
Yr: 2005 Vol: 41 Nbr: Abs: Pg:7-15

Factors affecting participation in a breast cancer risk reduction telephone survey among women from four racial/ethnic groups.
Periodical:Preventive Medicine
Index Medicus: Prev Med
Authors: Des Jarlais G, Kaplan CP, Haas JS, Gregorich SE, Pérez-Stable EJ, Kerlikowske K.
Yr: 2005 Vol: 41 Nbr: Abs: Pg:720-27