Risk Assessment for Breast Cancer Development and Its Clinical Impact on Screening Performance in Iranian Women

Abstract

Maryam Nikpour,1 Karimollah Hajian-Tilaki,2 Afsaneh Bakhtiari3 1Student Research Committee, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; 2Department of Biostatistics and Epidemiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran; 3Department of Midwifery, School of Medicine, Babol University of Medical Sciences, Babol, IranCorrespondence: Karimollah Hajian-TilakiDepartment of Biostatistics and Epidemiology, School of Medicine, Babol University of Medical Sciences, Babol, IranEmail [email protected]: The aim of this study is to estimate the objective and subjective risk and to examine their associations with three forms of breast cancer screening.Methods: This cross-sectional study was conducted with a sample of 800 women aged 35–85 years from the community setting and outpatient clinic in Babol, the north of Iran. The demographic, socio-economic characteristics and the risk factor profiles were collected through in-person interview. The health belief model (HBM) and visual analog scales were used to assess the women’s perceived risk of breast cancer. The practice of women regarding breast self-examination (BSE), breast clinical examination (BCE), and mammography were measured. We used the Gail model in estimating 5-year and lifetime risk. The logistic regression model was applied to determine the relationship of calculated and perceived risk on screening behaviors.Results: The mean of estimated 5-year and lifetime risk were 0.89 ±0.89 and 8.87 ±3.84 percent respectively while the perceived personal risk on visual scale perception was much greater than the calculated risk. The high 5-year calculated risk was a predictor of mammography practice but not BSE and BCE; however, after adjusting the subscales of HBM and socio-demographic characteristics, its effect remained significant (adjusted OR=1.97(95% CI: 1.02–3.08)). The perceived risk from HBM in particular self-efficacy (p=0.001) remained positively significant on all forms of screening practice.Conclusion: While the perceived risk from HBM scale was meaningful in screening performance, the calculated risk from the Gail model had a clinical impact on mammography behaviors independent of HBM scales.Keywords: breast cancer risk, the Gail model, the health belief model, perceived risk, the estimated risk, screening behaviors

Keywords

• breast cancer risk
• the gail model
• the health belief model
• perceived risk
• the estimated risk
• screening behaviors.