Risk reduction behaviors among individuals undergoing cancer risk assessment.

A8

Objective: Evaluation of environmental exposures and performance of risk reduction and preventative behaviors is an important component of cancer risk assessment (CRA). Tobacco use (TU) remains a significant contributor to cancer risk. Decreasing TU is a major national health objective. Cancer risk assessment and counseling programs (CRACP) may provide a unique opportunity to foster risk reduction behaviors such as smoking cessation. The goal of this study is to characterize TU and risk reduction behaviors among individuals attending a cancer risk assessment and counseling program.
 >Methods: Clinical chart review of 425 patients presenting for CRA at the University of Chicago Cancer Risk Clinic (07/2004 - 10/2006). Missing data excluded 145 charts; 280 charts were evaluated. Between groups differences assessed with Fisher exact (categorical) or Kruskal-Wallis (continuous) tests.
 >Results: Patients were 20 - 81 YO (mean = 44 years), 92% female, 74% white and 23% African American (AA). 46% had a personal cancer history. 10% were current TUs (CS); 34% had stopped TU (FS). 73% used sunscreen; 74% over 50 YO had >/= 1 colonoscopy; 84% women over 40YO had mammography in prior year. 90% women had PAP test in prior 2 years; CS and FS were less likely to have had PAPs (1 year: p = 0.004; 2 years: p = 0.03) than never smokers (NS). A greater proportion of men (22%) than women (9%) were CS (p = .05). Female CS appear to have greater lifetime risk of developing breast cancer (Claus model: 14.0%) than NS (4.6%) and FS (7.6%) (p = 0.05). FS were older (p = .02), but smoked fewer years (p < .01) than CS. CS were predicted less likely to have a BRCA1/2 mutation (BRCA PRO: 5.1%) than NS (16%) and FS (19.7%) (p = 0.02).
 >Conclusions: Despite higher rates of compliance with cancer screening guidelines than the general population, 10% of individuals presenting to a CRACP report current TU. Prior to undergoing CRA, 64% of those CS reported interest in tobacco cessation interventions. During CRA female CS were calculated to have a significantly greater lifetime risk of developing breast cancer, but a significantly lower likelihood of carrying a BRCA mutation than their NS and FS peers. Thus, CRACP may provide a “teachable moment”, an opportunity in the context of personalized risk information to engage individuals in smoking cessation. Continued data acquisition and multivariate analyses will allow greater characterization of the biopsychosocial factors that mediate the complex matrix of risk perceptions and ultimately inform the development of tailored interventions to foster performance of risk reduction behaviors in the context of CRACP.