Effect of oncologist-based counseling on patient-perceived breast cancer risk and psychological distress

Wilson C. Mertens, MD,^1,2 Deborah Katz, MD,^1,2 Marlene Quinlan, MSW,¹ Ruth Barham, MPH,¹ Sandra Hubbard, MSN, NP,¹ Pamela Hyder, RN,¹ Mary Jean Pineau, RN,¹ and Grace Makari-Judson, MD^1,2

¹Comprehensive Breast Center, Baystate Regional Cancer Program, Springfield, MA, and ²Tufts University School of Medicine, Boston, MA

Women often seek reassurance from oncologists regarding their risk of developing breast cancer. Patient-perceived risk frequently is higher than calculated estimates of risk. We assessed perceived breast cancer risk, perceived BRCA1/2 mutation carriage risk, and anxiety measured by the Brief Symptom Inventory-18 in 81 high-risk clinic patients before and immediately after risk counseling by an oncologist. Pre-counseling risk perceptions were much higher than calculated risk estimates. Perceived risk decreased significantly after counseling but continued to exceed calculated estimates and was correlated with pre-counseling perception. Post-counseling anxiety scores also declined but remained strongly correlated with pre-counseling anxiety scores and patient risk perceptions. Change in risk perceptions after counseling differed among physicians; change in anxiety levels did not. We conclude that oncologist-based counseling is effective in reducing anxiety despite persistent inaccuracy in patients’ perceived risk of developing breast cancer.

Commun Oncol 2008;5:108–114 print e-mail full text 123 kb