绝大多数女性错误估计自身乳腺癌风险

对近1万名接受乳房X线筛查的女性进行的一项调查显示，多数女性并未准确认识到自身的乳腺癌风险。

纽约霍夫斯特拉大学的妇产科专家Jonathan D. Herman医生在美国临床肿瘤学会(ASCO)乳腺癌研讨会上报告称，在估计自己的终身乳腺癌风险时，仅有9.4%的受访女性的估计值与实际累计风险的误差在10%以内。

“尽管有媒体的大量报道、知晓运动、粉红丝带活动、乳腺癌宣传月等形式多样的宣教，但多数女性仍然缺乏对自身乳腺癌风险的准确认识。女性低估自身乳腺癌风险的后果是什么？答案是她们很可能无法获得必需的或最精准的治疗。而另一方面，高估风险的女性又会过分担忧。”

在这项研究中，Herman医生及其同事对来自长岛地区21家乳房X线中心的9,873名年龄35~70岁、即将接受筛查的女性进行了调查。匿名问卷中的很多问题改编自国立癌症研究所乳腺癌风险评估工具，有需要者可在线获取该工具。

研究者将这些女性主观估计的风险与根据该工具计算出的风险进行对比。如果二者差异超过10%，即判定为估计不准确。

结果显示，多数女性的计算风险处于平均水平：35%的女性具有5%~10%的终身风险，40%的女性具有10%~15%的终身风险。然而，仅有9.4%的女性准确估计了自身风险，分别有46%和45%的女性高估和低估了自身风险。

种族是影响估计错误的重要因素。在白人女性中，10%准确估计了风险，分别有39%和51%低估和高估了风险。其他种族的女性则更倾向于低估乳腺癌风险。非裔女性有9%准确估计了风险，分别有58%和34%低估和高估了风险。亚裔女性的情况与非裔女性相似。

研究者指出，在理想情况下，女性应当从自己的医生那里了解到自身的乳腺癌风险，但该研究得出的结果却并非如此。“这些女性都即将接受乳房X线筛查，所以她们显然或多或少对自己的乳腺健康感兴趣。然而当被问及最近一次与医生讨论乳腺癌风险的时间时，令我们震惊的是，40%的女性表示从未与医务人员讨论过这一问题。”

这一发现提示，有必要改善初级保健医生与患者之间关于乳腺癌风险的沟通。同时也有必要鼓励患者询问自己的医生“我的乳腺癌风险有多高？我需要知道这个”。

本次新闻发布会的主持人、加州贝弗利山庄癌症研究所临床研究部主任Steven O’Day博士指出，这项研究有重要的启示意义。“在决定是否进行监测或化学预防时，患者和医生均对预后和风险作出准确判断是非常必要的。Herman医生计划开展的随访研究将告诉我们改善风险沟通的效果，这是非常重要的。即使在掌握了准确信息的情况下，要作出决定也是不容易的。假如没有掌握准确信息，我们就没法作决定了。”

Herman医生和O’Day博士均报告称无相关利益冲突。

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By: SUSAN LONDON, Internal Medicine News Digital Network

Most women do not have an accurate understanding of their breast cancer risk – a finding that has important implications for prevention and early detection, as well as psychological well-being, according to a survey of nearly 10,000 women undergoing mammography screening.

When asked to estimate their lifetime personal breast cancer risk, just 9.4% of the women gave a value that was within 10% of their actual calculated risk, according to data reported in a press briefing held in advance of the breast cancer symposium sponsored by the American Society of Clinical Oncology, where the study will be presented in full.

"Despite all the ongoing media attention, awareness campaigns, pink ribbons, breast cancer walks, and breast cancer month, most women lack accurate knowledge of their own breast cancer risk," maintained first author Dr. Jonathan D. Herman, an ob.gyn. at Hofstra University, New Hyde Park, N.Y. This tells us that "our education messaging is far off and we should change the way breast cancer awareness is presented."

"We began to think: What happens to women when they underestimate their risk of breast cancer? Well, they probably don’t get the necessary or most accurate treatment," he said. In particular, this group could benefit from a tailored plan of chemoprevention and early detection. On the other hand, "we think that women who overestimate their risk are worrying about getting breast cancer more than they really have to."

In the study, the investigators surveyed 9,873 women aged 35-70 years who were about to undergo screening at 21 Long Island mammography centers. The anonymous questionnaire included many questions adapted from the National Cancer Institute’s Breast Cancer Risk Assessment Tool, which is available online and typically used by physicians.

The women’s subjective estimate of risk was compared with their risk as calculated with the tool. Their estimate was considered inaccurate if it differed from their calculated risk by more than 10%.

Most of the women were at average calculated risk, with 35% having a 5%-10% lifetime risk and 40% having a 10%-15% lifetime risk.

Just 9.4% of the women, however, accurately estimated their risk, while 46% overestimated their risk and 45% underestimated their risk.

The predominant direction of estimation error varied by race/ethnicity. Of the white women, 10% accurately estimated their risk, 39% underestimated, and 51% overestimated their risk. Women of other ethnicities were more likely to underestimate their breast cancer risks. Just 9% of African American women were in line with their risk, with 58% underestimating and 34% overestimating. Asian women had similar assessments. Hispanic women’s inaccurate assessments were more balanced, with 50% underestimating and 41% overestimating risk. Although these differences were statistically significant, it is more important to note that the overall level of understanding was very low, Dr. Herman said.

Ideally, patients should learn of their breast cancer risk from their physician, he said, but the study data told another story. "All of these women were about to have mammography, so they obviously had some interest in their breast health," but when asked when they last spoke to their doctor about their personal breast cancer risk, "we were shocked to find that 40% of women said they never ever had a conversation with a health care provider," he reported.

The findings suggest a need to improve communication about risk by primary care providers, especially as the U.S. Preventive Services Task Force is now putting greater emphasis on informed decision making, Dr. Herman acknowledged.

But patients could be spurred to action as well, by moving beyond the pink ribbons and asking their physician, "What are my breast cancer numbers? I need to know that," he proposed.

Dr. Steven O’Day, director of clinical research at the Beverly Hills (Calif.) Cancer Institute and moderator of the press briefing, noted that the study has important implications for making use of guidelines for women at elevated risk. "To make decisions about chemoprevention, an accurate understanding of prognosis and risk both from the patient’s perspective and the physician’s is going to be essential to making good decisions in terms of surveillance and chemoprevention," he said.

A follow-up study planned by Dr. Herman will be important for informing efforts to improve risk communication, according to Dr. O’Day. "It’s a huge hurdle, yet how we are going to implement this [in primary care], as well as the tertiary-care oncology setting?" he commented. "If we don’t, the implications are huge; interventions by increased surveillance or chemoprevention are not trivial in terms of cost as well as potential side effects and morbidity. And these are difficult decisions even with accurate information. And without the information, you really can’t make any decision, in my mind."

Dr. Herman disclosed no relevant conflicts of interest. Dr. O’Day disclosed no relevant conflicts of interest.