Purpose/Objectives: To examine breast and ovarian cancer screening and risk-reducing behaviors of women seeking genetic cancer risk assessment (GCRA).
Design: Descriptive, cross-sectional.
Setting: An insurance-based clinic that serves high-risk patients in a southern California cancer center.
Sample: 134 women with breast or ovarian cancer (affected group) and 80 women with a family history of breast or ovarian cancer (unaffected group). The mean age of the sample was 48 years (range = 21-86), 79% were Caucasian, 66% were married, 60% were college educated, and 78% had children. Most affected women had early-stage disease. Unaffected women had a family history of breast (86%) or ovarian (14%) cancer.
Methods: Mailed surveys assessed pre-GCRA health behaviors and health and family histories.
Main Research Variables: Breast cancer screening (mammograms, clinical breast examination [CBE], breast self-examination), ovarian cancer screening (CA-125, pelvic ultrasound), and breast and ovarian cancer risk-reducing strategies (tamoxifen, bilateral mastectomy, oral contraceptive pills, bilateral salpingo-oophorectomy).
Findings: Twenty-one percent of the women who should have been having a mammogram had not had an annual examination as recommended, and 30% of affected women had not had annual CBEs. Few women took tamoxifen or oral contraceptive pills or had a bilateral salpingo-oophorectomy or bilateral mastectomy for cancer risk reduction. Twelve percent likely had unnecessary ovarian cancer screening. About 35% used other means, including herbs and homeopathy, for cancer prevention.
Conclusions: Nearly a third of the affected women had not had appropriate breast cancer screening. About 12% used unsubstantiated, potentially harmful cancer "prevention" measures (e.g., herbs).
Implications for Nursing: Nurses should assess clients' personal and family breast and ovarian cancer histories and promote cancer screening and risk-reducing behaviors that are appropriate for age and risk level.
American Society of Clinical Oncology. (2003). American Society of Clinical Oncology policy statement update: Genetic testing for cancer susceptibility. Journal of Clinical Oncology, 21, 2397-2406.
Austin, L.T., Ahmad, F., McNally, M.J., & Stewart, D.E. (2002). Breast and cervical cancer screening in Hispanic women: A literature review using the Health Belief Model. Women's Health Issues, 12, 122-128.
Bernstein, J.L., Thompson, W.D., Risch, N., & Holford, T.R. (1992). Risk factors predicting the incidence of second primary breast cancer among women diagnosed with a first primary breast cancer. American Journal of Epidemiology, 136, 925-936.
Bosompra, K., Flynn, B.S., Ashikaga, T., Rairikar, C.J., Worden, J.K., & Solomon, L.J. (2000). Likelihood of undergoing genetic testing for cancer risk: A population-based study. Preventive Medicine, 30, 155-166.
Botkin, J.R., Smith, K.R., Croyle, R.T., Baty, B.J., Wylie, J.E., Dutson, D., et al. (2003). Genetic testing for a BRCA1 mutation: Prophylactic surgery and screening behavior in women 2 years post testing. American Journal of Medical Genetics, 118A, 201-209.
Boyle, P., Maisonneuve, P., & Autier, P. (2000). Update on cancer control in women. International Journal of Gynaecology and Obstetrics, 70, 263-303.
Bunn, J.Y., Bosompra, K., Ashikaga, T., Flynn, B.S., & Worden, J.K. (2002). Factors influencing intention to obtain a genetic test for colon cancer risk: A population-based study. Preventive Medicine, 34, 567-577.
Champion, V.L. (1987). The relationship of breast self-examination to Health Belief Model variables. Research in Nursing and Health, 10, 375-382.
Champion, V.L. (1993). Instrument refinement for breast cancer screening behaviors. Nursing Research, 42, 139-143.
Cho, E., Spiegelman, D., Hunter, D.J., Chen, W.Y., Stampfer, M.J., Colditz, G.A., et al. (2003). Premenopausal fat intake and risk of breast cancer. Journal of the National Cancer Institute, 95, 1079-1085.
Claus, E.B., Risch, N., & Thompson, W.D. (1994). Autosomal dominant inheritance of early-onset breast cancer: Implications for risk prediction. Cancer, 73, 643-651.
Daly, M. (1999). NCCN practice guidelines: Genetics/familial high-risk cancer screening. Oncology, 13, 161-183.
DiGianni, L.M., Kim, H.T., Emmons, K., Gelman, R., Kalkbrenner, K.J., & Garber, J.E. (2003). Complementary medicine use among women enrolled in a genetic testing program. Cancer Epidemiology, Biomarkers and Prevention, 12, 321-326.
Easton, D.F., Bishop, D.T., Ford, D., Crockford, G.P., & the Breast Cancer Linkage Consortium. (1993). Genetic linkage analysis in familial breast and ovarian cancer: Results from 214 families. American Journal of Human Genetics, 52, 678-701.
Fishbein, M., Triandis, H.C., Kanfer, F.H., Becker, M., Middlestadt, S.E., & Eichler, A. (2001). Factors influencing behavior and behavior change. In A. Baum, T.A. Revenson, & J.E. Singer (Eds.), Handbook of health psychology (pp. 3-17). Mahwah, NJ: Lawrence Erlbaum.
Fisher, B., Costantino, J.P., Wickerham, D.L., Redmond, C.K., Kavanah, M., Cronin, W.M., et al. (1998). Tamoxifen for prevention of breast cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. Journal of the National Cancer Institute, 90, 1371-1388.
Ford, D., Easton, D.F., Stratton, M., Narod, S., Goldgar, D., Devilee, P., et al. (1998). Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium. American Journal of Human Genetics, 62, 676-689.
Frank, T.S., Deffenbaugh, A.M., Reid, J.E., Hulick, M., Ward, B.E., Lingenfelter, B., et al. (2002). Clinical characteristics of individuals with germline mutations in BRCA1 and BRCA2: Analysis of 10,000 individuals. Journal of Clinical Oncology, 20, 1480-1490.
Gail, M.H., Brinton, L.A., Byar, D.P., Corle, D.K., Green, S.B., Schairer, C., et al. (1989). Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. Journal of the National Cancer Institute, 81, 1879-1886.
Hartmann, L.C., Degnim, A., & Schaid, D.J. (2004). Prophylactic mastectomy for BRCA1/2 carriers: Progress and more questions. Journal of Clinical Oncology, 22, 981-983.
Hartmann, L.C., Schaid, D.J., Woods, J.E., Crotty, T.P., Myers, J.L., Arnold, P.G., et al. (1999). Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. New England Journal of Medicine, 340, 77-84.
International Society of Nurses in Genetics, Inc. (1998). Statement on the scope and standards of genetics clinical nursing practice. Washington, DC: American Nurses Publishing.
Isaacs, C., Peshkin, B.N., Schwartz, M., Demarco, T.A., Main, D., & Lerman, C. (2002). Breast and ovarian cancer screening practices in healthy women with a strong family history of breast or ovarian cancer. Breast Cancer Research and Treatment, 71, 103-112.
Jacobs, L.A. (2002). Health beliefs of first-degree relatives of individuals with colorectal cancer and participation in health maintenance visits: A population-based survey. Cancer Nursing, 25, 251-265.
Jemal, A., Murray, T., Ward, E., Samuels, A., Tiwari, R.C., Ghafoor, A., et al. (2005). Cancer statistics, 2005. CA: A Cancer Journal for Clinicians, 55, 10-30.
Katapodi, M.C., Lee, K.A., Facione, N.C., & Dodd, M.J. (2004). Predictors of perceived breast cancer risk and the relation between perceived risk and breast cancer screening: A meta-analytic review. Preventive Medicine, 38, 388-402.
King, M.C., Marks, J.H., & Mandell, J.B. (2003). Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science, 302, 643-646.
Kriege, M., Brekelmans, C.T., Boetes, C., Besnard, P.E., Zonderland, H.M., Obdeijn, I.M., et al. (2004). Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. New England Journal of Medicine, 351, 427-437.
Kurzer, M.S. (2003). Phytoestrogen supplement use by women. Journal of Nutrition, 133, 1983S-1986S.
Leitch, A.M., Dodd, G.D., Costanza, M., Linver, M., Pressman, P., McGinnis, L., et al. (1997). American Cancer Society guidelines for the early detection of breast cancer: Update 1997. CA: A Cancer Journal for Clinicians, 47, 150-153.
Lu, L.J., Anderson, K.E., Grady, J.J., Kohen, F., & Nagamani, M. (2000). Decreased ovarian hormones during a soya diet: Implications for breast cancer prevention. Cancer Research, 60, 4112-4121.
MacDonald, D.J. (2002). Women's decisions regarding management of breast cancer risk. Medsurg Nursing, 11, 183-186.
MacDonald, D.J., Sarna, L., Uman, G.C., Grant, M., & Weitzel, J.N. (2005). Health beliefs of women with and without breast cancer seeking genetic cancer risk assessment. Cancer Nursing, 28, 372-379.
McGarvey, E.L., Clavet, G.J., Johnson, J.B., II, Butler, A., Cook, K.O., & Pennino, B. (2003). Cancer screening practices and attitudes: Comparison of low-income women in three ethnic groups. Ethnicity and Health, 8, 71-82.
Meiser, B., Butow, P., Barratt, A., Friedlander, M., Kirk, J., Gaff, C., et al. (2000). Breast cancer screening uptake in women at increased risk of developing hereditary breast cancer. Breast Cancer Research and Treatment, 59, 101-111.
Metcalfe, K., Lynch, H.T., Ghadirian, P., Tung, N., Olivotto, I., Warner, E., et al. (2004). Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. Journal of Clinical Oncology, 22, 2328-2335.
Narod, S.A., Brunet, J.S., Ghadirian, P., Robson, M., Heimdal, K., Neuhausen, S.L., et al. (2000). Tamoxifen and risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: A case-control study. Hereditary Breast Cancer Clinical Study Group. Lancet, 356, 1876-1881.
Narod, S.A., Dube, M.P., Klijn, J., Lubinski, J., Lynch, H.T., Ghadirian, P., et al. (2002). Oral contraceptives and the risk of breast cancer in BRCA1 and BRCA2 carriers. Journal of the National Cancer Institute, 94, 1773-1779.
Narod, S.A., & Offit, K. (2005). Prevention and management of hereditary breast cancer. Journal of Clinical Oncology, 23, 1656-1663.
National Comprehensive Cancer Network. (2005). Genetic/familial high-risk assessment: Breast and ovarian. Retrieved May 31, 2005, from http://www.nccn.org/professionals/physician_gls/PDF/genetics_screening.pdf
NIH consensus conference. Ovarian cancer. Screening, treatment, and follow-up. NIH Consensus Development Panel on Ovarian Cancer. (1995). JAMA, 273, 491-497.
Oncology Nursing Society. (2004a). Cancer predisposition genetic testing and risk assessment counseling. Retrieved October 1, 2004, from http://www.ons.org/publications/positions/documents/pdfs/CancerPredisposition.pdf
Oncology Nursing Society. (2004b). The role of the oncology nurse in cancer genetic counseling. Retrieved October 1, 2004, from http://www.ons.org/publications/positions/documents/pdfs/CancerGenetic.pdf
Paley, P.J., Swisher, E.M., Garcia, R.L., Agoff, S.N., Greer, B.E., Peters, K.L., et al. (2001). Occult cancer of the fallopian tube in BRCA-1 germline mutation carriers at prophylactic oophorectomy: A case for recommending hysterectomy at surgical prophylaxis. Gynecologic Oncology, 80, 176-180.
Rebbeck, T.R. (2000). Prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers. Journal of Clinical Oncology, 18(21, Suppl.), 100S-103S.
Rebbeck, T.R., Friebel, T., Lynch, H.T., Neuhausen, S.L., van't Veer, L., Garber, J.E., et al. (2004). Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: The PROSE study group. Journal of Clinical Oncology, 22, 1055-1062.
Rebbeck, T.R., Lynch, H.T., Neuhausen, S.L., Narod, S.A., Van't Veer, L., Garber, J.E., et al. (2002). Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. New England Journal of Medicine, 346, 1616-1622.
Robson, M., Svahn, T., McCormick, B., Borgen, P., Hudis, C.A., Norton, L., et al. (2005). Appropriateness of breast-conserving treatment of breast carcinoma in women with germline mutations in BRCA1 or BRCA2: A clinic-based series. Cancer, 103, 44-51.
Schildkraut, J.M., Calingaert, B., Marchbanks, P.A., Moorman, P.G., & Rodriguez, G.C. (2002). Impact of progestin and estrogen potency in oral contraceptives on ovarian cancer risk. Journal of the National Cancer Institute, 94, 32-38.
SGO Committee. (2005). Society of Gynecologic Oncologists Clinical Practice Committee statement on prophylactic salpingo-oophorectomy. Gynecologic Oncology, 98, 179-181.
Smith, I.E., Dowsett, M., Ebbs, S.R., Dixon, J.M., Skene, A., Blohmer, J.U., et al. (2005). Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination: The immediate pre-operative anastrozole, tamoxifen, or combined with tamoxifen (IMPACT) multicenter double-blind randomized trial. Journal of Clinical Oncology, 23, 5108-5116.
Smith, R.A., Cokkinides, V., & Eyre, H.J. (2005). American Cancer Society guidelines for the early detection of cancer, 2005. CA: A Cancer Journal for Clinicians, 55, 31-44.
Smith, R.A., Mettlin, C.J., Davis, K.J., & Eyre, H. (2000). American Cancer Society guidelines for the early detection of cancer. CA: A Cancer Journal for Clinicians, 50, 34-49.
Struewing, J.P., Hartge, P., Wacholder, S., Baker, S.M., Berlin, M., McAdams, M., et al. (1997). The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. New England Journal of Medicine, 336, 1401-1408.
Tavani, A., Bosetti, C., Dal Maso, L., Giordano, L., Franceschi, S., & La Vecchia, C. (2004). Influence of selected hormonal and lifestyle factors on familial propensity to ovarian cancer. Gynecologic Oncology, 92, 922-926.
Tinley, S.T., Houfek, J., Watson, P., Wenzel, L., Clark, M.B., Coughlin, S., et al. (2004). Screening adherence in BRCA1/2 families is associated with primary physicians' behavior. American Journal of Medical Genetics, 125A, 5-11.
Wargovich, M.J., Woods, C., Hollis, D.M., & Zander, M.E. (2001). Herbals, cancer prevention and health. Journal of Nutrition, 131(11, Suppl.), 3034S-3036S.
Whittemore, A.S., Balise, R.R., Pharoah, P.D., Dicioccio, R.A., Oakley-Girvan, I., Ramus, S.J., et al. (2004). Oral contraceptive use and ovarian cancer risk among carriers of BRCA1 or BRCA2 mutations. British Journal of Cancer, 91, 1911-1915.
Winer, E.P., Hudis, C., Burstein, H.J., Wolff, A.C., Pritchard, K.I., Ingle, J.N., et al. (2005). American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: Status report 2004. Journal of Clinical Oncology, 23, 619-629.
Ziogas, A., Gildea, M., Cohen, P., Bringman, D., Taylor, T.H., Seminara, D., et al. (2000). Cancer risk estimates for family members of a population-based family registry for breast and ovarian cancer. Cancer Epidemiology, Biomarkers and Prevention, 9, 103-111.