Women over-estimate breast cancer risk

The disconnect between the facts and women’s beliefs about breast cancer was shown again in a USA Today story. Excerpts:

“A vast majority of American women plan to ignore controversial new recommendations about mammograms, a USA TODAY/Gallup Poll shows. The poll also shows that most women sharply overestimate their risk of developing the disease. …

Forty percent of women estimate that a 40-year-old’s chance of developing breast cancer over the next decade is 20% to 50%. The real risk is 1.4%, according to the National Cancer Institute.”

Woloshin chart.png Is it any wonder that women say they’ll ignore the USPSTF recommendations when they over-estimate their own risk by such a huge degree! And such over-estimation of risk is not new – having been reported consistently through the years.

The story includes this chart, with figures that get lost in the rhetoric.

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November 27, 2009 at 8:12 pm

Yes, but here’s another statistic:
Breast cancer is the leading cause of death for women ages 15-54. Not heart disease. Not lung cancer. Not traffic accidents. Breast cancer.
Here’s another statistic: few cancer treatments are as mutilating as breast cancer. Okay, I made this one up, but here’s my point: the numbers you cite make it sound like women are hysterical about this issue without cause. In fact, women are not hysterical, but we are concerned, and with good reason. We “youngsters” are tired of being told how “survivable” breast cancer is, especially when it means we lose the one feature that is valued by mates above all: tits. Show me the numbers on how many 30-year old mastectomy patients go on to get married, have kids, and lead full lives, and I’ll show you calmer women. Second, the risk of breast cancer may be low for younger women, but it’s a deadlier disease, and it’s not preventable through lifestyle choices the way (we are told, at any rate) that lung cancer and heart disease are.
And there’s an experiential side to breast cancer risk that outweighs the statistics for most women. To understand, try this little experiment: show up at work one day and say “ayyyyy, my best friend just got diagnosed with breast cancer!” I predict the following: if you work in an office of at least 50 people, at least 10 will come forward and say “yeah, my mother too…. my sister… both of my aunts… my cousin…don’t worry honey, I survived it and she will too.” This experiential factor speaks more loudly than all the epidemiology in the world to a whole lot of folks. It may be irrelevant to individual risk, but it happens, it makes an impression, and it sure doesn’t feel like “1.4%”.
One final point: a lot of women (but not all) understand that there’s a huge difference between a 1.4% age-adjusted population risk, and an utterly unknown and unknowable (except for BRCA patients) individual risk. Again, if we had a reasonable model for this, it would make a difference, but we don’t. So any given woman feels either lucky or doomed, depending on how much he/she has brushed up against breast cancer lately; and there are millions of breast cancer patients out there to brush up against.
Does that help you understand a little better why women worry about this disease in what seems a disproportionate-to-the-epidemiology degree? On a related note, I often hear doctors complain that heart disease is a far greater risk factor but women don’t worry enough about it. This is what I’d love to tell them: age-adjust those numbers, and the answer will stare you in the face.

Gary Schwitzer

November 27, 2009 at 9:46 pm

Thanks for your note.
You wrote: “the numbers you cite make it sound like women are hysterical about this issue without cause.”
How does my statement of fact “make it sound” like what you implied?
Consistently, over and over, women have been shown to overestimate their risk of breast cancer.
That’s a fact.
You can interpret that however you wish, but please don’t make it sound like your interpretation was mine. There is nothing in what I wrote that even remotely suggests that women are hysterical about this issue.