Grant Details
Grant Number: |
5R01CA279953-02 Interpret this number |
Primary Investigator: |
Scherer, Laura |
Organization: |
University Of Colorado Denver |
Project Title: |
Understanding and Addressing Rejection of Personalized Cancer Risk Information |
Fiscal Year: |
2024 |
Abstract
PROJECT SUMMARY/ABSTRACT
We are entering an era of precision medicine for cancer screening in which screening initiation and
maintenance is based on personal risk estimates that incorporate multiple risk factors, with the goal of
maximizing screening benefits and minimizing the harms. One increasingly common clinical application
involves using cancer risk prediction models to inform which patients are screened, how often they are
screened, and at which ages screening occurs (i.e., risk-based screening). For breast cancer screening with
mammography, the U.S. Preventive Services Task Force recommends informed choice about when to begin
regular screening for women age 40-49. Making an informed choice means determining whether, for an
individual woman, the likelihood of receiving a screening benefit outweighs the likelihood of harms such as
false positive results and overdiagnosis. A critical component of informed choice is a woman’s personal cancer
risk, because the expected benefit of screening depends on a woman’s personal risk of breast cancer, with
women at lower risk being less likely to benefit and more likely to be harmed than women at higher risk.
Hence, incorporating informed choice into the mammography screening decision-making process means that
women are asked to make decisions about screening based on their personalized breast cancer risk
estimates. However, a critical barrier to implementing guideline-recommended informed choice in
mammograpy screening is that many people reject that their risk estimate is true for them personally, a
phenomenon we refer to as risk rejection. While previous research has focused on risk comprehension as a
high-impact target for improving medical decisions, we argue that risk rejection is also a high impact target for
improving health decision making because people who reject their risk are unlikely to make health decisions
based on that risk estimate, even when they comprehend the estimate. An estimated 1-in-4 women believe
that their breast cancer risk estimate is not accurate for them, and little is known about why, or the implications
for screening decisions. In Aim 1, we will use a longitudinal survey to understand the scientific nature of risk
rejection. Aim 1a will identify key demographic and psychological predictors of risk rejection. In particular, we
will test 4 theory-informed hypotheses about why people reject their risk: motivated reasoning, prior
knowledge, distrust, and lack of perceived personal relevance. Aim 1b will identify the impact of risk rejection
on risk-concordant screening behavior. In Aim 2, we will conduct interviews and use experiments to identify
communication strategies to reduce risk rejection. These studies will provide a comprehensive understanding
of a phenomenon – risk rejection – which, if not addressed, will impede the implementation of informed patient
choice in breast cancer screening and personalized, risk-based medicine more broadly.
Publications
Assessing and Understanding Reactance, Self-Exemption, Disbelief, Source Derogation and Information Conflict in Reaction to Overdiagnosis in Mammography Screening: Scale Development and Preliminary Validation.
Authors: Scherer L.D.
, Suresh K.
, Lewis C.L.
, McCaffery K.J.
, Hersch J.
, Cappella J.N.
, Morse B.
, Tate C.E.
, Mosley B.S.
, Schmiege S.
, et al.
.
Source: Medical decision making : an international journal of the Society for Medical Decision Making, 2023 Oct-Nov; 43(7-8), p. 789-802.
EPub date: 2023-09-14.
PMID: 37705500
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