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    Factors that Influence Breast Cancer Risk Appraisal among Elderly African American and Caucasian Women

    Scientific Abstract:
    Factors that Influence Breast Cancer Risk Appraisal Among Elderly Women Background: Elderly (>65 years) women’s breast cancer risk appraisals are incongruent with their actual breast cancer risk. Yet, accurate appraisal is needed to make informed decisions regarding effective coping strategies. Prior experience caring for a loved one with cancer, fear, guilt, and anxiety all interfere with the ability to accurately appraise risk information, and, can inhibit implementation of secondary prevention practices known to reduce breast cancer morbidity and mortality. The complex construct of risk perception has typically been measured using a single item scale. This lack of a psychometrically adequate breast cancer risk appraisal scale inhibits the conduct of sound research. Objectives/Hypothesis: This study’s objective is to address the knowledge gap related to the absence of a reliable and valid scale to measure this construct due to the unknown factors that contribute to breast cancer risk perception. Specific Aims: 1) Conduct focus style group interviews to identify the components of the breast cancer risk appraisal process; 2) Develop age and culturally appropriate scale items for each appraisal component identified; 3) Assess the psychometric properties of the Breast Cancer Risk Appraisal Scale (BCRAS) among elderly African American and Caucasian women. Study Design: Given the understudied cohort targeted for this work, this is a descriptive, exploratory study. During the qualitative phase, I will conduct interviews with key community advisors to learn the most effective, feasible, and culturally congruent recruitment methods and data collection strategies. I will then conduct 3-5 focus style group interviews to identify key components of the breast cancer risk appraisal process. Each group will consist of 6-10 elderly African American and Caucasian women with no personal history of breast cancer. In the quantitative phase, I will develop and pilot-test the BCRAS among a similar cohort to assess its psychometric properties. Potential Outcomes and Benefits: Reduction of breast health disparities among this cohort will be advanced through the creation of a scale that is a psychometrically sound, age and culturally appropriate measure of breast cancer risk appraisal. This is a vital first step to identify the root cause of inaccurate breast cancer risk perception, promote congruence between perceived and objective risk, and create tailored interventions based on risk appraisal that improve adherence to early detection measures.

    Lay Abstract:
    Factors that Influence Breast Cancer Risk Appraisal Among Elderly Women Background: Elderly (> 65 years) women represent the highest risk group for breast cancer incidence and death. African Americans are at even higher risk for death as their breast cancer is often diagnosed at an advanced stage. Despite the burden of such increased risk due to age, race, and its combination, both of these groups are underserved and understudied in relation to breast cancer prevention. Knowledge of actual and perceived breast cancer risk is an important motivator of breast screening behavior. However, among elderly women, perceived risk is often lower than degree of actual risk. Such inaccurate perceptions are a barrier to regular mammography screening, which is effective in reducing breast cancer deaths. Studies that compared actual and perceived risk typically used a single item scale to measure risk perception. However, single item scales do not adequately represent this complex construct. Objective/Hypothesis: This study seeks to identify components of the breast cancer risk appraisal process and use that knowledge to develop a reliable and valid Breast Cancer Risk Appraisal Scale (BCRAS). Aims:1) Conduct focus style group interviews to identify the components of the breast cancer risk appraisal process; 2) Develop age and culturally appropriate scale items for each appraisal component identified; 3) Assess the degree of reliability and validity of the BCRAS among elderly African American and Caucasian women. Design: I will begin by interviewing key community advisors to learn the most effective, feasible, and culturally congruent recruitment methods and data collection strategies. Then, 3-5 focus style group interviews will be conducted to identify key components of breast cancer risk appraisal. Each group will consist of 6-10 elderly African American and Caucasian women with no personal history of breast cancer. Next, I will develop the BCRAS and pilot-test it with a larger group to assess its degree of reliability and validity. Potential Outcomes and Benefits: Reduction of breast health disparities among this at risk group will be advanced through the creation of a scale that is a statistically sound, age and culturally appropriate measure of breast cancer risk appraisal. This is a vital first step to identify the root cause of inaccurate breast cancer risk appraisal, promote congruence between perceived and actual risk, and create tailored interventions based on risk appraisal that improve adherence to early detection measures that serve to reduce breast cancer deaths.