1. Public health messages impact on adolescent girls: misperceptions and fears Carolee Polek RN, PhD, AOCNS Thomas Hardie, RN, EdD, PMHCNS-BC

2. Aims Breast health recommendations change with expanding evidence including: self-breast exam timing, mammography, and rates of alcohol consumption. Women left with lingering concerns regarding the reliability of public health messages which may be most impactful in adolescent women. This study explores the ambient perceptions/ misperceptions of adolescent girls and of breast health risks.

3. Background 226,870 new cases of invasive breast cancer will be diagnosed 2012 (ACS, 2012). The etiology of a portion of these are modifiable behaviors. Risk and protective behaviors are learned, adopted, or experimented with during adolescence. Behaviors are a function of misperceived or misunderstood personal risk.

4. Cancer prevention, public health and media messages. Breast cancer screening messages have been successful in enhancing rates of screening at the population level. These are targeted at adult women. These efforts encourage programs for BSE in younger women. Breast cancer risk are often in the news and provide a changing landscape of things to avoid. For some this is mind numbing, mixing fear and an ever increasing number of current or future risks.

5. Breast cancer 1.7-4% (mother, any age) 2-3% (sister, any age) 3.6-5% (sister, premenopausal) 2% (sister, postmenopausal) 11% (sister, bilateral) Ovarian cancer3.9-4% (first-degree relative) Colon cancer 3-4% (mother or father) 3-7% (brother or sister) Prostate cancer2-5% (first-degree relative) Malignant melanoma2.7% (first-degree relative) Risks expressed are relative risks (the increased risk as compared to a control population), not absolute risks (the actual likelihood of developing the disease). These risks do not apply to families with a known familial cancer syndrome. Source: Adapted from Clinical Cancer Genetics By Ken Offit ISBN 0-471-25154-2 Copyright January 1998 by Wiley-Liss, Inc. Adaptation of Table 6-1 on page 217

6. Common misperceptions Adolescent misperceptions (Weiss 2008) 23% infection, drug use, stress, and tanning 10-20% caffeine, antiperspirant, or getting bumped or bruised 7% breastfeeding, (author’s finding ~22%) 30% of girls have perceived a normal change as breast cancer Adult misperceptions African American women have a fatalistic beliefs. Broad confusion about personal risks, genetics and heredity Underwire bra Abortion Deodorant Implants

7. Methods: Nine piloted questions to 636 girls (14 to 19 Yrs.) from 13 high schools Results: > 50% injury to breast > 50% tanning breasts > 50% thought ETOH/drug consumption no risk 40% thought all lumps were breast cancer 40% tobacco caused breast cancer 30% healthy weight and exercise had no impact 20% scared by public health breast cancer messages.

8. Follow up study of 336 HS girls

9. Discussion Similar to Weiss our findings suggest ongoing misperceptions that may increase cancer risks. Ongoing analyses suggest race/ethnic differences. Currently evaluating if these are associated with SES or cultural differences. 1/3 of girls fear (and potentially avoid) public health messages.

10. Conclusions Find a more effective way to talk about risk to all women but perhaps more importantly to adolescent girls. Yesterday the vitamins were a cure today they are a risk Two drinks good for your heart but you will loose your breast to cancer if too much ETOH Attempt to simplify complex health risks to sound bites may help or support misperceptions and or junk science. Current recommendations suggest messages for adolescents should emphasize an understanding of breast development/breast health.

11. Misperception Questions 1. Tanning my breast will cause breast cancer. 2. Drinking coffee causes breast cancer. 3. Getting an infection will cause breast cancer. 4. Breast cancer can be caused by a sports related injury to your chest. 5. Alcohol and drug use can cause breast cancer. 6. If your mother or sister has breast cancer, you will get breast cancer. 7. Stress causes breast cancer. 8. Breast feeding increases my risk for breast cancer. 9. Smoking causes breast cancer.

12. References American Cancer Society. (2012). Cancer Facts & Figures 2012 Weiss, M. C., & Friedman, I. (2008). Taking Care of Your Girls: A Breast Health Guide for Girls, Teens, and In-Betweens. New York: Three Rivers Press.

13. Acknowledge BBHI adolescent breast health program Biden Breast Health Initiative (BBHI) P.O. Box 4616 Wilmington, DE 19807 302-658-1545 bbhi@comcast.net