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Association Between Cancer Risk Perception and Screening Behavior Among Diverse Women
Sue E. Kim, PhD, MPH;
Eliseo J. Pérez-Stable, MD;
Sabrina Wong, RN, PhD;
Steve Gregorich, PhD;
George F. Sawaya, MD;
Judith M. E. Walsh, MD, MPH;
Celia P. Kaplan, DrPH, MA
Arch Intern Med. 2008;168(7):728-734.
Background We measured the perception of breast, cervical, and colon cancer risks and screening in diverse women to examine the association between risk perception and screening behavior.
Methods Cross-sectional telephone and in-person interviews of women aged 50 to 80 years were conducted in English, Spanish, or Chinese. The women were recruited from primary care practices in San Francisco, California (academic general internal medicine, family medicine, women's health practices, a community-based clinic in Chinatown, and the Community Health Network Clinics, which is affiliated with the San Francisco Department of Public Health), with at least 1 visit within the previous 2 years. Perceived personal risk for each cancer was measured on a word scale (no risk to very high risk) and compared with self-reported screening behavior by ethnicity.
Results A total of 1160 women participated: 338 (29%) were White, 167(14%) were African American, 239 (21%) were Latina, and 416 (36%)were Asian. The average participant was 61 years old and a high school graduate; 18% had a personal history of cancer, and 42% had a family history of cancer. The perceived lifetime risk of cancer varied by ethnicity. Compared with White women, Latinas had a higher perceived risk for cervical cancer (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.6) and colon cancer (OR, 3.0; 95% CI, 1.8-5.0) after multivariate adjustment, and Asians had a lower perceived risk for cervical cancer (OR, 0.6; 95% CI, 0.4-0.9) and colon cancer (OR, 0.6; 95% CI, 0.3-0.9). Higher colon cancer risk perception was associated with having undergone colonoscopy within 10 years (OR, 2.8; 95% CI, 1.4-5.4).
Conclusions Risk perception was significantly associated with colon cancer screening behavior (P = .001). Evaluation of patients' perceived risk of cancer may be useful to clinicians who are recommending screening tests.
Author Affiliations: Division of General Internal Medicine, Department of Medicine (Drs Kim, Pérez-Stable, Gregorich, Walsh, and Kaplan), Medical Effectiveness Research Center for Diverse Populations (Drs Kim, Pérez-Stable, Wong, Gregorich,Sawaya, Walsh, and Kaplan), Comprehensive Cancer Center (Drs Kim, Pérez-Stable, Walsh, and Kaplan), and Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Sawaya), University of California, San Francisco; and School of Nursing Culture, Gender, and Health Unit and Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, Canada (Dr Wong).
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