Components of the Risk Assessment Process
A thorough understanding of these issues can greatly inform genetic education and counseling. These factors influence the processing of risk information and subsequent health behaviors.
The communication of risk involves the delivery of quantitative information regarding what the data indicate about the likelihood of developing illness given various preventive actions. More broadly, however, risk communication is an interactive process regarding the individual's knowledge, beliefs, emotions, and behaviors associated with risk, as well as the risk message conveyed. Accordingly, the goal of risk communication may be to impact the individual's knowledge of risk factors, risk likelihoods, potential consequences of risk, and the benefits and drawbacks of preventive actions.
Even before the provision of risk information, the provider may anticipate that the individual already has some sense of his or her own risk of cancer. The individual may have derived this information from multiple sources, including physicians, family members, and the media. This information may be more salient or emotional if a family member has recently died from cancer or if there is a new family diagnosis.[16,17] Additionally, individuals may have beliefs about how genetic susceptibility works in their family.[18,19] For example, in a family where only females have been affected with an autosomal dominant cancer susceptibility syndrome thus far, it may be difficult to convince the consultand that her sons have a 50% risk for inheriting the disease-related mutation. The social-ecological context through which risk beliefs develop and are maintained are important as potential moderators of individuals' receptivity to the cancer risk communication process and also represent the context in which individuals will return to continue ongoing decision-making about how to manage their risk.[20,21] As such, individuals' beliefs, and the social context of risk, are important to discuss in education and genetic risk counseling.
Perceived risk can play an important role in an individual's decision to participate in counseling, despite the fact that perceived risk often varies substantially from statistical risk estimates.[23,24,25]
Personal health history
Consideration of the consultand's personal health history is essential in cancer risk assessment, regardless of whether the individual has a personal history of cancer. Important information to obtain about the consultand's health history includes the following:
- Current age.
- Race and ethnicity.
- History of benign or malignant tumors, surgeries, biopsies, major illnesses, medications, and reproductive history (for women, this includes age at menarche, parity, age at first live birth, age at menopause, and history of exogenous hormone use).
- Environmental exposures.
- Diet and exercise practices.
- Complementary and alternative medicine practices.
- Past and current alcohol intake and tobacco use.
- Screening practices and date of last screening exams, including imaging and/or physical examinations.[4,6,26]