Risk perceptions, worry, and attitudes about genetic testing for breast cancer susceptibility

Abstract

This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N = 303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior.

Keywords:

• Risk perception
• health attitudes
• self-regulation theory
• genetic testing
• cognitive processes
• worry

Acknowledgements

We thank Kevin McCaul and two anonymous reviewers for their valuable comments on earlier versions of this article.

Notes

1. Recently, researchers have begun to favor the term “risk-reducing surgery” over “prophylactic surgery” in order to better convey that these surgeries do not eliminate cancer risk. Because the study measures and materials used the term “prophylactic surgery”, we use this term when referring directly to the study assessments.

2. First-degree relatives at average, medium, and high familial risk did not differ in their genetic testing interest or their beliefs regarding health benefits, distress consequences, and utility of prophylactic surgeries; p's > 0.70.

3. To verify that the observed negative associations of perceived risk with the genetic testing beliefs (as reflected by the negative β values) are not due to suppressor effects, we created high vs. low worry groups and high vs. low perceived risk groups using median splits of the score distributions and then calculated the testing beliefs means (health and psychosocial benefits, distress consequences, and utility of prophylactic surgeries) for these four independent groups. In each case, the testing attitude means were higher in the low perceived risk groups than in the high perceived risk groups. The dichotomous variables are less sensitive than the continuous variables and so their relationships with the testing attitudes are muted, but the general patterns of the group means demonstrate that lower perceived risk is, in fact, associated with higher attitude ratings; the significance levels of the perceived risk group main effects are p < 0.05 for utility of prophylactic surgery, p < 0.09 for distress consequences, and p < 0.21 for benefits beliefs.