Predictors of perceived breast cancer risk and the relation between perceived risk and breast cancer screening: a meta-analytic review

Background. Perceived risk is a principal variable in theoretical models that attempt to predict the adoption of health-protective behaviors. Methods. This meta-analysis synthesizes findings from 42 studies, identified in PubMed and PsycInfo from 1985 onward. Studies examined demographic and psychological variables as predictors of perceived breast cancer risk and the relationship between perceived risk and breast cancer screening. Statistical relationships, weighted for sample size, were transformed to effect sizes and 95% CIs. Results. Women do not have accurate perceptions of their breast cancer risk (N = 5,561, g = 1.10). Overall, they have an optimistic bias about their personal risk (g = 0.99). However, having a positive family history (N = 70,660, g = 0.88), recruitment site, and measurement error confounded these results. Perceived risk is weakly influenced by age (N = 38,000, g = 0.13) and education (N = 1,979, g = 0.16), and is moderately affected by race/culture (N = 2,192, g = 0.38) and worry (N = 6,090, g = 0.49). There is an association between perceived risk and mammography screening (N = 52,766, g = 0.19). It is not clear whether perceived risk influences adherence to breast self-examination. Women who perceived a higher breast cancer risk were more likely to pursue genetic testing or undergo prophylactic mastectomy. Conclusion. Perceived breast cancer risk depends on psychological and cognitive variables and influences adherence to mammography screening guidelines.