Predictors of Cancer Worry in Unaffected Women from High Risk Breast Cancer Families: Risk Perception is not the Primary Issue

Some women at increased familial risk of breast cancer experience elevated levels of cancer-specific worry, which can possibly act as a barrier to screening, and may be a significant factor in decisions regarding risk-reducing surgery. The aim of this study was to comprehensively examine predictors of cancer-specific worry in high risk women and to test a model which proposes that perceived breast cancer risk mediates the impact of other factors on worry. 1,437 unaffected women from high risk breast cancer families completed questionnaires and interviews. Path analysis was used to test the model of potential predictors of cancer worry, including familial, personal and psychological variables, mediated via perceived cancer risk. Levels of cancer-specific worry were generally low despite an average perceived risk of 50.3%. The goodness-of-fit of the proposed model was poor, explaining only 9% of the variance for perceived risk and 10% of the variance for cancer specific worry. An alternative model of a direct relationship between all of the predictor variables and cancer worry, explained 24% of the variation in cancer worry. General anxiety, perceived risk, the stressful impact of recent cancer related events, a relative risk greater than 10, being closer in age to the youngest breast cancer diagnosis in family, and knowledge of personal mutation status, all independently contributed to cancer worry. Addressing general affective responses, experiences of recent cancer related events, in addition to education about personal risk, should be considered in counselling women with elevated cancer worry. Risk perception appears to act independently of other factors in its formulation and impact on cancer worry. Further research on the way in which women come to perceive their risk is indicated. The kConFab Psychosocial Group are (in alphabetical order of institution): Brain and Mind Institute, University of Sydney, Australia (I Hickie) Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia (K-A Phillips) Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia (B Bennett, B Meiser, K Tucker) Department of Oncology, St Vincent’s Hospital, Melbourne, Australia (S-A MaLachlan) Department of Psychological Medicine, Royal North Shore Hospital, St Leonards, Australia (C Tennant); Medical Psychology Research Unit, University of Sydney, Australia (P Butow, M Price).