Many Breast Cancer Patients Overestimate Risk of Recurrence and Spread Interview with:

Sarah T. Hawley PhD MPH Professor of Medicine University of Michigan

Dr. Sarah Hawley

Sarah T. Hawley PhD MPH
Professor of Medicine
University of Michigan

Medical Research: What is the background for this study? What are the main findings?

Dr. Hawley: Research has shown that breast cancer patients do not have a good understanding of their risk of distant recurrence, and and that the fear of cancer spreading is one of the biggest concerns that patients have. The research that has been done shows that most patients over-esimate this risk, and think they have a bigger chance of the cancer coming back than they actually have. There has been relatively little done to investigate the association between patient over-estimation of risk and patient reported outcomes, specifically their quality of life. We therefore conducted our study to understand the extent of overestimation of risk in a population-based sample of breast cancer patients with very favorable prognosis (DCIS, low risk invasive breast cancer) using a numeric (number based) and descriptive (general understanding) measure, and to understand the association between over-estimation and quality of life.

The main findings are that almost 40% of our sample of patients over-estimated their risk; 33% using a numeric measure and 15% using a descriptive measure. There was no clear “type” of patient who overestimated her risk of distant recurrence, though women with lower education more over overestimated numerically than those with higher education.

Both numeric and descriptive over-estimation was associated with reduced quality of life outcomes, especially with frequency of worry about recurrence, however over estimating descriptively mattered the most. Women who overestimated their risk both numerically and descriptively had a nearly 10 fold odds of frequent worry compared to women who understood their risk.

Medical Research: What should clinicians and patients take away from your report?

Dr. Hawley: Over-estimation of the risk of distant recurrence is common among patients, even those with very favorable prognosis, and there is no clear type of patient who appears more or less likely to misunderstand and overestimate her risk (though care should be paid to lower education). Clinicians should take time to discuss patients’ actual risk of cancer spreading distantly, and especially to ensure that patients have a good general (descriptive) sense that this risk is low.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Hawley: Future work will continue to explore the long term impact of over-estimation on quality of life, but also on patient health care behaviors. Do patients who over-estimate their risk use more services in an attempt to manage their risk? We are also interested in exploring the group of women who UNDER estimate their risk.

Medical Research: Is there anything else you would like to add?

Dr. Hawley: Continued efforts are needed to try and ensure that cancer patents have an accurate understanding of their risk of both local and distant recurrence; these concepts can be difficult for patients to understand and understandably matter a lot to them. In addition to clinicians’ discussion of these concepts, tools and materials to help patients understand their risk may be useful.


Abstract presented at the  2016 Quality Care Symposium February 26-27, 2016, 2016 Phoenix Arizona

Recurrence risk perception and quality of life after treatment of breast cancer

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Sarah T. Hawley PhD MPH (2016). Many Breast Cancer Patients Overestimate Risk of Recurrence and Spread