No votes yet

Cancer Screening and Risk-Reducing Behaviors of Women Seeking Genetic Cancer Risk Assessment for Breast and Ovarian Cancers

Deborah J. MacDonald
Linda Sarna
Gwen C. Uman
Marcia Grant
Jeffrey N. Weitzel
ONF 2006, 33(2), E27-E35 DOI: 10.1188/06.ONF.E27-E35

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. <i>Journal of Clinical Oncology, 21</i>, 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. <i>Women's Health Issues, 12</i>, 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. <i>American Journal of Epidemiology, 136</i>, 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. <i>Preventive Medicine, 30</i>, 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 <i>BRCA1</i> mutation: Prophylactic surgery and screening behavior in women 2 years post testing. <i>American Journal of Medical Genetics, 118A</i>, 201-209.

Boyle, P., Maisonneuve, P., & Autier, P. (2000). Update on cancer control in women. <i>International Journal of Gynaecology and Obstetrics, 70</i>, 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. <i>Preventive Medicine, 34</i>, 567-577.

Champion, V.L. (1987). The relationship of breast self-examination to Health Belief Model variables. <i>Research in Nursing and Health, 10</i>, 375-382.

Champion, V.L. (1993). Instrument refinement for breast cancer screening behaviors. <i>Nursing Research, 42</i>, 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. <i>Journal of the National Cancer Institute, 95</i>, 1079-1085.

Claus, E.B., Risch, N., & Thompson, W.D. (1994). Autosomal dominant inheritance of early-onset breast cancer: Implications for risk prediction. <i>Cancer, 73</i>, 643-651.

Daly, M. (1999). NCCN practice guidelines: Genetics/familial high-risk cancer screening. <i>Oncology, 13</i>, 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. <i>Cancer Epidemiology, Biomarkers and Prevention, 12</i>, 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. <i>American Journal of Human Genetics, 52</i>, 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.), <i>Handbook of health psychology</i> (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. <i>Journal of the National Cancer Institute, 90</i>, 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 <i>BRCA1</i> and <i>BRCA2</i> genes in breast cancer families. The Breast Cancer Linkage Consortium. <i>American Journal of Human Genetics, 62</i>, 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 <i>BRCA1</i> and <i>BRCA2</i>: Analysis of 10,000 individuals. <i>Journal of Clinical Oncology, 20</i>, 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. <i>Journal of the National Cancer Institute, 81</i>, 1879-1886.

Hartmann, L.C., Degnim, A., & Schaid, D.J. (2004). Prophylactic mastectomy for <i>BRCA1/2</i> carriers: Progress and more questions. <i>Journal of Clinical Oncology, 22</i>, 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. <i>New England Journal of Medicine, 340</i>, 77-84.

International Society of Nurses in Genetics, Inc. (1998). <i>Statement on the scope and standards of genetics clinical nursing practice</i>. 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. <i>Breast Cancer Research and Treatment, 71</i>, 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. <i>Cancer Nursing, 25</i>, 251-265.

Jemal, A., Murray, T., Ward, E., Samuels, A., Tiwari, R.C., Ghafoor, A., et al. (2005). Cancer statistics, 2005. <i>CA: A Cancer Journal for Clinicians, 55</i>, 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. <i>Preventive Medicine, 38</i>, 388-402.

King, M.C., Marks, J.H., & Mandell, J.B. (2003). Breast and ovarian cancer risks due to inherited mutations in <i>BRCA1</i> and <i>BRCA2. Science, 302</i>, 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. <i>New England Journal of Medicine, 351</i>, 427-437.

Kurzer, M.S. (2003). Phytoestrogen supplement use by women. <i>Journal of Nutrition, 133</i>, 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. <i>CA: A Cancer Journal for Clinicians, 47</i>, 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. <i>Cancer Research, 60</i>, 4112-4121.

MacDonald, D.J. (2002). Women's decisions regarding management of breast cancer risk. <i>Medsurg Nursing, 11</i>, 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. <i>Cancer Nursing, 28</i>, 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. <i>Ethnicity and Health, 8</i>, 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. <i>Breast Cancer Research and Treatment, 59</i>, 101-111.

Metcalfe, K., Lynch, H.T., Ghadirian, P., Tung, N., Olivotto, I., Warner, E., et al. (2004). Contralateral breast cancer in <i>BRCA1</i> and <i>BRCA2</i> mutation carriers. <i>Journal of Clinical Oncology, 22</i>, 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 <i>BRCA1</i> and <i>BRCA2</i> mutation carriers: A case-control study. Hereditary Breast Cancer Clinical Study Group. <i>Lancet, 356</i>, 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 <i>BRCA1</i> and <i>BRCA2</i> carriers. <i>Journal of the National Cancer Institute, 94</i>, 1773-1779.

Narod, S.A., & Offit, K. (2005). Prevention and management of hereditary breast cancer. <i>Journal of Clinical Oncology, 23</i>, 1656-1663.

National Comprehensive Cancer Network. (2005). <i>Genetic/familial high-risk assessment: Breast and ovarian</i>. Retrieved May 31, 2005, from <a target="_blank" href='http://www.nccn.org/professionals/physician_gls/PDF/genetics_screening.p...

NIH consensus conference. Ovarian cancer. Screening, treatment, and follow-up. NIH Consensus Development Panel on Ovarian Cancer. (1995). <i>JAMA, 273</i>, 491-497.

Oncology Nursing Society. (2004a). <i>Cancer predisposition genetic testing and risk assessment counseling</i>. Retrieved October 1, 2004, from <a target="_blank" href='http://www.ons.org/publications/positions/documents/pdfs/CancerPredispos...

Oncology Nursing Society. (2004b). <i>The role of the oncology nurse in cancer genetic counseling</i>. Retrieved October 1, 2004, from <a target="_blank" href='http://www.ons.org/publications/positions/documents/pdfs/CancerGenetic.p...

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 <i>BRCA-1</i> germline mutation carriers at prophylactic oophorectomy: A case for recommending hysterectomy at surgical prophylaxis. <i>Gynecologic Oncology, 80</i>, 176-180.

Rebbeck, T.R. (2000). Prophylactic oophorectomy in <i>BRCA1</i> and <i>BRCA2</i> mutation carriers. <i>Journal of Clinical Oncology, 18</i>(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 <i>BRCA1</i> and <i>BRCA2</i> mutation carriers: The PROSE study group. <i>Journal of Clinical Oncology, 22</i>, 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 <i>BRCA1</i> or <i>BRCA2</i> mutations. <i>New England Journal of Medicine, 346</i>, 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 <i>BRCA1</i> or <i>BRCA2</i>: A clinic-based series. <i>Cancer, 103</i>, 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. <i>Journal of the National Cancer Institute, 94</i>, 32-38.

SGO Committee. (2005). Society of Gynecologic Oncologists Clinical Practice Committee statement on prophylactic salpingo-oophorectomy. <i>Gynecologic Oncology, 98</i>, 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. <i>Journal of Clinical Oncology, 23</i>, 5108-5116.

Smith, R.A., Cokkinides, V., & Eyre, H.J. (2005). American Cancer Society guidelines for the early detection of cancer, 2005. <i>CA: A Cancer Journal for Clinicians, 55</i>, 31-44.

Smith, R.A., Mettlin, C.J., Davis, K.J., & Eyre, H. (2000). American Cancer Society guidelines for the early detection of cancer. <i>CA: A Cancer Journal for Clinicians, 50</i>, 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 <i>BRCA1</i> and <i>BRCA2</i> among Ashkenazi Jews. <i>New England Journal of Medicine, 336</i>, 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. <i>Gynecologic Oncology, 92</i>, 922-926.

Tinley, S.T., Houfek, J., Watson, P., Wenzel, L., Clark, M.B., Coughlin, S., et al. (2004). Screening adherence in <i>BRCA1/2</i> families is associated with primary physicians' behavior. <i>American Journal of Medical Genetics, 125A</i>, 5-11.

Wargovich, M.J., Woods, C., Hollis, D.M., & Zander, M.E. (2001). Herbals, cancer prevention and health. <i>Journal of Nutrition, 131</i>(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 <i>BRCA1</i> or <i>BRCA2</i> mutations. <i>British Journal of Cancer, 91</i>, 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. <i>Journal of Clinical Oncology, 23</i>, 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. <i>Cancer Epidemiology, Biomarkers and Prevention, 9</i>, 103-111.