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Comparison of Breast Cancer Risk Estimations, Risk Perception, and Screening Behaviors in Obese Rural Korean Women

SoMi Park

Barbara B. Cochrane

Sang Baek Koh

ChaeWeon Chung

breast cancer, breast neoplasms, cancer screening, Screening, cancer risk, risk factors, rural issues, obesity, mammography
ONF 2011, 38(6), E394-E401. DOI: 10.1188/11.ONF.E394-E401

Purpose/Objectives: To assess three breast cancer risk assessment tools in obese rural Korean women.

Design: Cross-sectional survey design.

Setting: Community settings in the rural region of northeastern South Korea.

Sample: A nested cohort sample of 64 severely obese women aged 40-60 years from the Korean Genomic Regional Cohort registry.

Methods: The Breast Cancer Risk Assessment Tool of the National Cancer Institute (BCRAT-NCI), Breast Cancer Risk Appraisal for Korean Women (BCRA-K), and Estimation of Individualized Probabilities of Developing Breast Cancer for Korean Women (EIPDBC-K) were used for interview data. Mammography, women's perceptions, and screening behaviors also were analyzed.

Main Research Variables: Breast cancer risk assessment, mammography findings, women's perceptions of breast cancer risk, and breast cancer screening behaviors.

Findings: A total of 5 (BCRAT-NCI), 19 (BCRA-K), and 43 (EIPDBC-K) women were at higher (above average or high) risk for breast cancer. The BCRA-K (r = 0.28, p < 0.05) and EIPDBC-K (r = 0.43, p < 0.001) correlated with mammography findings. However, the BCRAT-NCI correlated only with the BCRA-K. Women's breast self-examination (χ2 = 4.77, p < 0.05) and mammography findings (χ2 = 5.22, p < 0.05) differed according to their risk perception.

Conclusions: Risk assessment by the BCRA-K and EIPDBC-K was related to mammography findings. Women's perception of breast cancer risk influenced their screening behaviors. When choosing a risk assessment tool, healthcare professionals should consider the ethnic and cultural backgrounds of the target population.

Implications for Nursing: Healthcare professionals should use appropriate risk assessment tools in breast cancer education and counseling to help women understand their risk factors and adopt proper health behaviors.

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    Ahn, S.H., & Yoo, K.Y. (2006). Chronological changes of clinical characteristics in 31,115 new breast cancer patients among Koreans during 1996-2004. Breast Cancer Research and Treatment, 99, 209-214. doi:10.1007/s10549-006-9188-x
    American Cancer Society. (2011). Breast cancer facts and figures 2011-2012. Retrieved from
    American College of Radiology. (2010). BI-RADS®-Mammography, fourth edition. Retrieved from
    Amy, N. K., Aalborg, A., Lyons, P., & Keranen, L. (2006). Barriers to routine gynecological cancer screening for White and African American obese women. International Journal of Obesity, 30, 147-155.
    Bondy, M.L., Lustbader, E.D., Halabi, S., Ross, E., & Vogel, V.G. (1994). Validation of a breast cancer risk assessment model in women with a positive family history. Journal of the National Cancer Institute, 86, 620-625. doi:10.1093/jnci/86.8.620
    Buxton, J.A., Bottorff, J.L., Balneaves, L.G., Richardson, C., McCullum, M., Ratner, P.A., & Hack, T. (2003). Women's perceptions of breast cancer risk: Are they accurate? Canadian Journal of Public Health, 94, 422-426.
    Chan, S.S., Chow, D.K., Loh, E.Y., Wong, D.N., Cheng, K.K., Fung, W.Y., & Cheung, P.S. (2007). Using a community-based outreach program to improve breast health awareness among women in Hong Kong. Public Health Nursing, 24, 265-273. doi:10.1111/j.1525-1446.2007.00633.x
    Edwards, Q.T., Maradiegue, A., Seibert, D., Saunders-Goldson, S., & Humphreys, S. (2009). Breast cancer risk elements and nurse practitioners' knowledge, use, and perceived comfort level of breast cancer risk assessment. Journal of the American Academy of Nurse Practitioners, 21, 270-277. doi:10.1111/j.1745-7599.2009.00405.x
    Eibner, F., Barth, J., Helmes, A., & Bengel, J. (2006). Variations in subjective breast cancer risk estimations when using different measurements for assessing breast cancer risk perception. Health Risk and Society, 8, 197-210. doi:10.1080/13698570600677407
    Euhus, D.M. (2001). Understanding mathematical models for breast cancer risk assessment and counseling. Breast Journal, 7, 224-232.
    Evans, D.G., Blair, V., Greenhalgh, R., Hopwood, P., & Howell, A. (1994). The impact of genetic counseling on risk perception in women with a family history of breast cancer. British Journal of Cancer, 70, 934-938.
    Fernante, J.M., Chen, P.H., Crabtree, B.F., & Wartenberg, D. (2007). Cancer screening in women: Body mass index and adherence to physician recommendation. American Journal of Preventive Medicine, 32, 525-531. doi:10.1016/j.amepre.2007.02.004
    Fletcher, S.W., Black, W., Harris, R., Rimer, B.K., & Shapiro, S. (1993). Report of the international workshop on screening for breast cancer. Journal of the National Cancer Institute, 85, 1664-1656.
    Fontaine, K.R., Heo, M., & Allison, D.B. (2001). Body weight and cancer screening among women. Journal of Women's Health and Gender-Based Medicine, 10, 463-470. doi:10.1089/152460901300233939
    Gail, M.H., Brinton, L.A., Byer, D.P., Corle, D.K., Green, S.B., Schairer, C., & Mulvihill, J.J. (1989). Projecting individualized probabilities of developing breast cancer for White females who are being examined annually. Journal of the National Cancer Institute. Monographs, 81, 1879-1886. doi:10.1093/jnci/81.24.1879
    Gapstur, S.M., Lopez, P., Colangelo, L.A., Wolfman, J., VanHorn, L., & Hendrick, R.E. (2003). Associations of breast cancer risk factors with breast density in Hispanic women. Cancer Epidemiology, Biomarkers and Prevention, 12, 1074-1080.
    Gerber, B., Müller, H., Reimer, T., Krause, A., & Friese, K. (2003). Nutrition and lifestyle factors on the risk of developing breast cancer. Breast Cancer Research and Treatment, 79, 265-276. doi:10.1023/A:1023959818513
    Han, M.Y., & Chung, C.W. (2006). Breast cancer screening behaviors in working women. Korean Journal of Women Health Nursing, 12, 363-370.
    Hay, J.L., McCaul, K.D., & Magnan, R.E. (2006). Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence. Preventive Medicine, 42, 401-408.
    Henderson, B.J., Tyndel, S., Brain, K., Clements, A., Bankhead, C., Austoker, J., … Macmillan, D. (2008). Factors associated with breast cancer-specific distress in younger women participating in a family history mammography screening program. Psycho-Oncology, 17, 74-82. doi:10.1002/pon.1201
    Hu, F.B. (2003). Overweight and obesity in women: Health risks and consequences. Journal of Women's Health, 12, 163-172.
    Huang, Z., Hankinson, S.E., Colditz, G.A., Stampfer, M.J., Hunter, D.J., Manson, J.E., … Willett, W.C. (1997). Dual effects of weight and weight gain on breast cancer risk. JAMA, 278, 1407-1411.
    Jee, S.H., Yun, J.E., Park, E.J., Cho, E.R., Park, I.S., Sull, J.W., … Samet, J.M. (2008). Body mass index and cancer risk in Korean men and women. International Journal of Cancer, 123, 1892-1896. doi:10.1002.ijc.23719
    Katapodi, M.C., Dodd, M.J., Lee, K.A., & Facione, N.C. (2009). Underestimation of breast cancer risk: Influence on screening behavior. Oncology Nursing Forum, 36, 306-314. doi:10.1188/09.ONF.306-314
    Kim, B.H., Koh, S.B., Hur, H.K., Park, J.K., & Park, S.M. (2009). Women's cancer screening according to body mass index in a cohort of rural Korean women. Journal of Korean Academy of Nursing, 39, 641-650.
    Kim, S.H., Chae, Y.S., Son, W.J., Shin, D.J., Kim, Y.M., & Chang, M.C. (2008). Estimation of individualized probabilities of developing breast cancer for Korean women. Journal of the Korean Surgical Society, 74, 405-411.
    Korean Statistical Information Service. (2010). Household income, expenditure. Retrieved from,%20Expenditure
    Lee, C.Y., Ko, I.S., Kim, H.S., Lee, W.H., Chang, S.B., Min, J.S., … Han, J.H. (2004). Development and validation study of the breast cancer risk appraisal for Korean women. Nursing and Health Sciences, 6, 201-207. doi:10.1111/j.1442-2018.2004.00193.x
    Lerman, C., Hughes, H., Croyle, R.T., Main, D., Durham, C., Snyder, C., … Lynch, H.T. (2000). Prophylactic surgery decisions and surveillance practices one year following BRCA1/2 testing. Preventive Medicine, 31, 75-80. doi:10.1006/pmed.2000.0684
    Lobb, E.A., Butow, P.N., Barratt, A., Meiser, B., Gaff, C., Young, M.A., … Tucker, K. (2004). Communication and information-giving in high-risk breast cancer consultations: Influence on patient outcomes. British Journal of Cancer, 90, 321-327. doi:10.1038/sj.bjc.6601502
    McTiernan, A. (2000). Associations between energy balance and body mass index and risk of breast carcinoma in women from diverse, racial and ethnic backgrounds in the U.S. Cancer, 88, 1248-1255.
    McTiernan, A. (2003). Behavioral risk factors in breast cancer: Can risk be modified? Oncologist, 8, 326-334.
    Ministry for Health, Welfare and Family Affairs, & Korea Centers for Disease Control and Prevention. (2008). The statistics of public health (2007): The 4th national health and nutrition survey of Korea [In Korean]. Retrieved from
    Mitchell, R.S., Padwal, R.S., Chunk, A.W., & Klarenbach, S.W. (2008). Cancer screening among the overweight and obese in Canada. American Journal of Preventive Medicine, 35, 127-132. doi:10.1016/j.amepre.2008.03.031
    Nahcivan, N.O., & Secginli, S. (2007). Health beliefs related to breast self-examination in a sample of Turkish women. Oncology Nursing Forum, 34, 425-432. doi:10.1188/07.ONF.425-432
    National Cancer Center. (2011). Annual report of cancer statistics in Korea in 2008. Retrieved from
    National Cancer Information Center. (2011). The occurrence of cancer incidence trends 1999-2008 [In Korean]. Retrieved from
    National Cancer Institute. (2002). Breast cancer risk assessment tool. Retrieved from
    National Comprehensive Cancer Network. (2011). NCCN Clinical Practice Guidelines in Oncology: Breast cancer risk reduction [v.3.2011]. Retrieved from
    Ou, S.W., Yoo, T.W., Huh, B.Y., Ahn, Y.O., Yun, Y.H., & Shin, S.A. (2002). Search for criterion of obesity through analysis of morbidity and mortality in Korean obesity. Korean Journal of Obesity, 11, 304-311.
    Park, S.M., Hur, H.K., Kim, G.Y., & Song, H.Y. (2007). Knowledge, barriers, and facilitators of Korean women and their spouses in the contemplation stage of breast self-examination. Cancer Nursing, 30, 78-84.
    Park, S.M., Song, H.Y., Hur, H.K., & Kim, G.Y. (2009). Effects of a cognition-oriented breast self-examination intervention for Korean women and their spouses. Public Health Nursing, 26, 259-268. doi:10.1111/j.1525-1446.2009.00778.x
    Rothemund, Y., Paepke, S., & Flor, H. (2001). Perception of risk, anxiety, and health behaviors in women at high risk for breast cancer. International Journal of Behavioral Medicine, 8, 230-239.
    Sabatino, S.A., Burns, R.B., Roger, B.D., Phillips, R.S., Chen, Y., & McCarthy, E.P. (2004). Breast carcinoma screening and risk perception among women at increased risk for breast carcinoma: Results from a national survey. Cancer, 100, 2338-2346. doi:10.1002/cncr.20274
    Selvan, M.S., Wilkinson, A.V., Chamberlain, R., & Bondy, M.L. (2004). Social and dietary changes associated with obesity and breast cancer risk. Journal of Health Management, 6, 103-114.
    Sohl, S.J., & Moyer, A. (2007). Tailored interventions to promote mammography screening: A meta-analytic review. Preventive Medicine, 45, 252-261. doi:10.1016/j.ypmed.2007.06.009
    Song, Y., Sung, J., & Ha, M. (2008). Obesity and risk of cancer in postmenopausal Korean women. Journal of Clinical Oncology, 29, 3395-3402. doi:10.1200/JCO.2007.15.7867
    Spiegelman, D., Colditz, G.A., Hunter, D., & Hertzmark, E. (1994). Validation of the Gail et al. model for predicting individual breast cancer risk. Journal of the National Cancer Institute, 86, 600-607.
    Stephenson, G.D., & Rose, D.P. (2003). Breast cancer and obesity: An update. Nutrition and Cancer, 45, 1-16. doi:10.1207/S15327914NC4501_1
    Tice, J.A., Cummings, S.R., Smith-Bindman, R., Ichikawa, L., Barlow, W.E., & Kerlikowske, K. (2008). Using clinical factors and mammographic breast density to estimate breast cancer risk: Development and validation of a new predictive model. Annals of Internal Medicine, 148, 337-347.
    Yoo, G.Y., Noh, D.Y., & Choi, K.J. (1995). Epidemiological aspects of breast cancer among Korean women. Korean Journal of Epidemiology, 17, 30-47.