Age-dependent impact of breast cancer risk perception on mammography screening behavior in Brazilian women

Abstract Background: Previous studies suggest that education and income affect Brazilian women’s breast cancer prevention behavior. The present study focused on the impact of perceived risk on mammography screening behavior. Methods: Information regarding socioeconomic variables and risk perception was obtained from 396 healthy women aged 40 - 79 years. Absolute and comparative perceived risk was measured on a seven-point Likert scale. Perceived numeric risk was measured on a percentage scale A Breast Cancer Risk Assessment Tool of five-year and lifetime risk of developing invasive breast cancer was used to estimate real risk. Regression analysis was applied to determine odds ratios (OR) and confidence intervals (95%CI) of independent variables. Results: Women without family history, aged 40 - 49 years and ≥ 50 years, had a 5.777 (95%CI: 2.261- 14.764) and 9.239 (95%CI: 4.028- 21.194) higher chance, respectively, of having low perceived absolute risk (p = 0.000). Regression modelling revealed that women aged between 40 and 49 years with low perceived absolute risk and low educational level, performed regular mammography screening about 2.7 (OR = 0.377; 95%CI: 0.143-0.989; p = 0.037 and OR = 0.368; 95%CI: 0.100-1.360; p = 0.040) times less often, compared to those ones with high risk perception and high educational level. Education was the only significant variable for women aged ≥ 50 years (p = 0.021): Women with low educational level underwent annual and biannual mammography about 3.5 (OR = 0.289; 95%CI: 0.035- 2.363) and 23.3 (OR = 0.043; 95%CI: 0.004- 0.420) times less often, respectively, than did women with high education level. Overestimation of numeric and comparative perceived risk, respectively, indicated a negative association with participation in mammography screening (p = 0.021; p = 0.017). Conclusions: Perception of absolute risk depended on family history. The effect of risk perception on mammography screening was age group-dependent, particularly for women aged 40 - 49 years, whereas for women aged ≥ 50 years, educational level had a more prominent effect. Overestimation of risk was not positively associated with increased adherence on mammography screening.