COLORECTAL CANCER

Four primary themes emerged during the focus group discussions reflecting the beliefs and concerns of the study participants. Two of these—knowledge of cancer risk factors and inaccurate perceptions of personal risk—may be linked to poor risk communication in the healthcare setting and reports of the limited discussions with healthcare professionals in this context. First, both African-American and Hispanic participants had limited knowledge of the risk factors that increase the likelihood of developing breast. The relationship between aging and cancer was poorly understood, and the majority of participants did not mention or address aging as an important risk factor in the development of either breast or colorectal cancer. They were largely unaware of the breast cancer risk factors related to estrogen production and childbearing, as well.

Women’s limited knowledge of breast cancer risk factors has been documented in other studies as well. Data from the 1992 National Health Interview Survey Cancer Control Supplement indicated that the majority of respondents were unable to identify the major risk factors. Approximately two-thirds of participants in this study did not recognize the importance of age as a risk factor. Other studies have reported similar findings regarding women’s lack of awareness of age as a risk factor for developing cancer.

A second theme was that perceptions of personal risk were not based on accurate knowledge of risk factors or awareness of any models that are currently in use to assess risk—nor were they based on discussions with physicians, according to participants’ reports. This is a particularly important theme since provider risk communication, discussions about the importance of screening, and recommendations to obtain screening have been shown to predict compliance with screening guidelines. Lower rates of mammography screening have been observed for African Americans than for whites, even with equal access through primary care and health maintenance organizations. A 30% reduction in breast cancer mortality could be achieved if 80% of women ages 50-74 engaged in annual mammography screening.

Participants in this study believed that their healthcare providers didn’t share information about the cancer risk factors with them that were discussed in the focus groups, because they lived in poor communities. Other studies have confirmed that communication by primary care providers may not be uniform among diverse patient populations. African-American patients report receiving less information about personal breast cancer risk factors and fewer opportunities for participatory decision-making in medical appointments than do whites.

A third theme was that participants were eager to receive information about cancer risk factors and identified clear preferences for how information about their personal levels of risk was communicated to them. They preferred formats that they thought were individualized to convey their level of risk, favoring graphs that were based on personal risk factors, like family history. This is important information for healthcare providers who discuss screening as a way to monitor risk with low-income, minority female patients. Using these types of materials can facilitate these discussions. erectalis 20 mg

Other studies have similarly identified the appeal of lists of personal risk factors when quantifying risk. In a Cochrane Review of personalized risk communication and informed screening decisions, Edwards et al. (2003) surveyed randomized controlled trials that were designed to offer personalized risk communication and reported on the cognitive, affective, and behavioral outcomes of the communication interventions. They compared three approaches to risk communication and determined that more-detailed risk communication, involving numerical calculations of personal risk, was associated with lower levels of screening tests. For risk communication presenting numerical calculations of risk (first approach), the odds ratio for screening uptake was 1.22 (95% CI=0.56-2.68). Studies that categorized personal risk into high, medium, or low strata of risk yielded an OR of 1.42 (95% CI=1.07-1.88) for screening uptake. For the third approach, the listing of personal risk factors, the OR was 1.7 (95% CI=1.17-2.48).

A study conducted by Hallowell et al. (1997) evaluated formats for presenting risk information during genetic counseling of breast and ovarian cancers and found that 73% of the sample preferred risk to be described using quantitative formats, with little difference among those preferring percentages, proportions, or population comparisons. In over 40% of cases, risk information was not presented in the preferred quantitative format.

A fourth theme was that women of both ethnic groups had very limited knowledge about colorectal cancer. While they were aware that family history was a risk factor, even those reporting family histories of this  didn’t identify this as a problem for them to worry about. They asked the focus group moderators a lot of questions about the risk factors and terminology associated with the disease. They were confused about the cause of hemorrhoids and the relationship of hemorrhoids to colorectal cancer. Generally, they did not feel at risk for developing this disease unless they had experienced symptoms in the past.

For many women participants, the focus groups served as a learning forum about breast and colorectal cancer. To address their questions and concerns, they were provided with handouts at the conclusion of the breast cancer segment and again following the colorectal cancer segment that outlined cancer risk factors to facilitate educational dialogue and accurate understanding. The breast cancer sheets dis played a list of factors that either increased or reduced the risk of getting breast cancer. Among other items, the list included reproductive risk factors: age at menstrual onset, no children, and age at birth of first child. Reproductive factors, for both African Americans and Hispanics, were a source of many questions and much discussion. They did not appear to be as familiar with the cancer risk conveyed by reproductive factors as the others factors on the list, such as family history, ethnicity, and diet.

This was one of the first studies to investigate the process of risk communication in two low-income populations. Participant understanding of cancer risk factors and their preferences for tools conveying personal risk were examined. Focus group results indicated strong participant interest in strategies necessary to understand and reduce breast and colorectal cancer risk factors. Risk communication tools that participants evaluated favorably presented information about both family history and one’s personal risk in quantitative graphic formats.
canadian pharmacy viagra

Future studies with low-income populations should promote an understanding and appreciation of the difference between cancer risk factors which are not modifiable (e.g., reproductive risk factors for breast cancer, and family history of both cancers) and those that can be changed. Routine early detection, body mass index, diet, and physical activity can be modified to reduce cancer risk and are clearly important areas for intervention in low-income populations, which have high rates of obesity and sedentary lifestyle. Our findings indicate that African-American and Hispanic women are motivated to reduce their cancer risk factors and would benefit from interventions in the healthcare and community settings, which target colorectal cancer risk communication and prevention. Future interventions should deliver information about the personal risk of developing cancer, and ways to reduce this risk in formats that are meaningful and effectively address the special needs of these populations.