Breast cancer risk perceptions and breast cancer worry: what predicts what?

This longitudinal study explored the relationship between perceived breast cancer risk and worry. We measured both absolute and comparative risk perceptions, and also used the Gail algorithm to assess the accuracy of participants' risk perceptions. Three hundred and one women ages 40–75 participated in a two-part study assessing how format of breast cancer risk presentation affected perceptions of risk. Relative to their Gail scores, women were biased pessimistically about their own absolute breast cancer risk and yet largely accurate about their comparative breast cancer risk. Perceived comparative risk, but not perceived absolute risk or biases in absolute or comparative risk, predicted subsequent worry. Worry predicted subsequent perceived absolute risk and biases in absolute and comparative risk. These results suggest that women's emotional reactions to breast cancer risk are based on accurate (unbiased) perceptions of their comparative risks. In turn, greater worry prompts a re-evaluation of absolute risk as well as changes in risk biases. Implications for screening are discussed.