Are women's breast cancer risk appraisals in line with updated clinical risk estimates communicated? Results from a UK Family History Risk and Prevention Clinic.

Background: The incorporation of breast density and a polygenic risk score (PRS) into breast cancer risk prediction models can alter previously communicated risk estimates. Previous research finds that risk communication does not usually change personal risk appraisals. This study aimed to examine how women from the Family History Risk (FH-Risk) study appraise their breast cancer risk following communication of an updated risk estimate.

Methods: In the FH-Risk study 323 women attended a consultation to receive an updated breast cancer risk estimate. A subset (n=190) completed a questionnaire, assessing their subjective breast cancer risk appraisals, satisfaction with the information provided and cancer related worry. One hundred and three were notified of a decrease risk, 34 an increase and 53 an unchanged risk.

Results: Women's subjective risk appraisals were in line with the updated risk estimates provided, with age, a PRS and breast density explaining most of the variance in these appraisals. Those notified of an increased risk demonstrated higher subjective risk perceptions compared to those whose risk remained unchanged or decreased.

Conclusions: Women's subjective breast cancer risk appraisals are amenable to change following updated risk feedback, with new information breast density and a PRS accepted and integrated into existing risk appraisals. Trust in the service, the analogies and visual communication strategies used may have positively influenced the integration of this new information.

Impact: Further research is warranted to assess whether similar patterns emerge for other illnesses and in different clinical contexts to determine the best strategies for communicating updated risk estimates.