Breast cancer risk perception: what do we know and understand?

Identification of breast and ovarian cancer predisposing genes [1,2] has created a demand for personalized risk information in families with a cancer family history. Services have developed to respond to this new need, and genetic risk counselling for women with histories of familial breast or ovarian cancer is widely advocated [3,4,5]. Guidelines for clinicians have been published [4,6,7], and the need to tailor information to the individual's affective state and to consider pre-existing perceptions has been recognized [8]. Psychosocial research has explored women's knowledge of personal risk before and after genetic counselling, and has begun to determine the emotional costs and benefits of acquiring risk information. It is evident that a wide range of methods have been used to examine risk perceptions, resulting in apparently contradictory results. It is therefore timely to review the state of our knowledge about risk perception and to consider whether an accurate understanding of risk matters.Studies in the UK and USA have shown that women's perceptions of the population risk of cancer and their personal vulnerability are at variance with medical perspectives. Before genetic risk counselling, a minority of women have an accurate view of the chances of developing breast cancer, and the majority either over- or underestimate [9,10]. There are interesting differences between findings, with the extent of risk overestimation appearing to be much greater in studies conducted in the USA [11,12] and Canada [13] than in UK studies [9,10], which have sometimes identified a larger proportion of underestimators. These differences may be due to true cultural differences, although access to risk information and methodological differences (such as sample derivation and the measurement of risk perception) also contribute. Genetic risk counselling has been shown to improve significantly the accuracy of risk perception [10,11,12,14,15,16], but up to 30% of UK women and two-thirds