Views of low income women seeking care at a Federally Qualified Health Center (FQHC) regarding breast cancer risk assessment: A qualitative study

USPSTF recommends identifying candidates for breast cancer (BC) chemoprevention and genetic counseling in routine primary care. Little is known about how low-income women of color view individualized BC risk assessment (IRA) undertaken as part of routine care. Forty-three African American and Latina women seeking care at an FQHC with a policy of offering IRA at well-visits were interviewed 2 weeks post-IRA. Transcribed interviews were coded by two investigators using conventional content analysis.

Four themes emerged regarding the decision to learn IRA results: seeking reassurance; wanting to understand family history; perceiving that everyone is susceptible; and seeking guidance for future health care decisions. For women who accurately believed that they were at average risk prior to completing the IRA, risk assessment provided verification. Almost all women at increased risk suspected this prior to their IRA due to family history. However, some had never before talked to a healthcare provider about it and were not always clear on the precise relationship between family history and their personal risk. Interviews highlighted the complexity of “family history” given incomplete information about relatives’ disease and complex family structures. Independent of family history, women frequently mentioned knowing someone with cancer or the perception that cancer is “common” as motivation for learning about their risk. Many women knew that BC is preventable and treatable and viewed learning IRA results as an extension of early detection, emphasizing proactivity over fatalism.

Interest in IRA appears high among underserved women. This may be an effective method for addressing disparities in BC mortality.