Cancer health self-efficacy improvement in a randomized controlled trial.

BACKGROUND: eHealth interventions can help cancer survivors self-manage their health outside the clinic. Little is known about how best to engage and assist survivors across the age and cancer treatment spectra. METHODS: The American Cancer Society conducted a randomized controlled trial that assessed efficacy of, and engagement with, Springboard Beyond Cancer, an eHealth self-management program for cancer survivors. Intent-to treat analyses assessed effects of intervention engagement for treatment (on-treatment vs completed) overall (n = 176; 88 control, 88 intervention arm) and separately by age (<60 years vs older). Multiple imputation was used to account for participants who were lost to follow-up (n = 41) or missing self-efficacy data (n = 1) at 3 months follow-up. RESULTS: Self-efficacy for managing cancer, the primary outcome of this trial, increased significantly within the intervention arm and for those who had completed treatment (Cohen's d = 0.26, 0.31, respectively). Additionally, participants with moderate-to-high engagement in the text and/or web intervention (n = 30) had a significantly greater self-efficacy for managing cancer-related issues compared to the control group (n = 68), with a medium effect size (Cohen's d = 0.44). Self-efficacy did not differ between the intervention and control arm at 3 months post-baseline. CONCLUSIONS: Study results suggest that cancer survivors benefit variably from eHealth tools. To maximize effects of such tools, it is imperative to tailor information to a priori identified survivor subgroups and increase engagement efforts.

Associations Between Engagement and Outcomes in the SmokefreeTXT Program: A Growth Mixture Modeling Analysis.

INTRODUCTION: Smoking continues to be a leading cause of preventable death. Mobile health (mHealth) can extend the reach of smoking cessation programs; however, user dropout, especially in real-world implementations of these programs, limit their potential effectiveness. Research is needed to understand patterns of engagement in mHealth cessation programs. METHODS: SmokefreeTXT (SFTXT) is the National Cancer Institute's 6-8 week smoking cessation text-messaging intervention. Latent growth mixture modeling was used to identify unique classes of engagement among SFTXT users using real-world program data from 7090 SFTXT users. Survival analysis was conducted to model program dropout over time by class, and multilevel modeling was used to explore differences in abstinence over time. RESULTS: We identified four unique patterns of engagement groups. The largest percentage of users (61.6%) were in the low-engagers declining group; these users started off with low level of engagement and their engagement decreased over time. Users in this group were more likely to drop out from the program and less likely to be abstinent than users in the other groups. Users in the high engagers-maintaining group (ie, the smallest but most engaged group) were less likely to be daily smokers at baseline and were slightly older than those in the other groups. They were most likely to complete the program and report being abstinent. CONCLUSIONS: Our findings show the importance of maintaining active engagement in text-based cessation programs. Future research is needed to elucidate predictors of the various levels of engagement, and to assess whether strategies aimed at increasing engagement result in higher abstinence rates. IMPLICATIONS: The current study enabled us to investigate differing engagement patterns in non-incentivized program participants, which can help inform program modifications in real-world settings. Lack of engagement and dropout continue to impede the potential effectiveness of mHealth interventions, and understanding patterns and predictors of engagement can enhance the impact of these programs.

Processing of fallopian tube, ovary, and endometrial surgical pathology specimens: A survey of U.S. laboratory practices.

OBJECTIVE: Many high-grade serous carcinomas initiate in fallopian tubes as serous tubal intraepithelial carcinoma (STIC), a microscopic lesion identified with specimen processing according to the Sectioning and Extensive Examination of the Fimbria protocol (SEE-Fim). Given that the tubal origin of these cancers was recently recognized, we conducted a survey of pathology practices to assess processing protocols that are applied to gynecologic surgical pathology specimens in clinical contexts in which finding STIC might have different implications. METHODS: We distributed a survey electronically to the American Society for Clinical Pathology list-serve to determine practice patterns and compared results between practice types by chi-square (χ2) tests for categorical variables. Free text comments were qualitatively reviewed. RESULTS: Survey responses were received from 159 laboratories (72 academic, 87 non-academic), which reported diverse specimen volumes and percentage of gynecologic samples. Overall, 74.1% of laboratories reported performing SEE-Fim for risk-reducing surgical specimens (82.5% academic versus 65.7% non-academic, p < 0.05). In specimens from surgery for benign indications in which initial microscopic sections showed an unanticipated suspicious finding, 75.9% of laboratories reported using SEE-Fim to process the remainder of the specimen (94.8% academic versus 76.4% non-academic, p < 0.01), and 84.6% submitted the entire fimbriae. CONCLUSIONS: Changes in the theories of pathogenesis of high-grade serous carcinoma have led to implementation of pathology specimen processing protocols that include detailed analysis of the fallopian tubes. These results have implications for interpreting trends in cancer incidence data and considering the feasibility of developing a bank of gynecologic tissues containing STIC or early cancer precursors.

Electronic Health Information Exchange Opportunities for Self-management of Care: Responses from Older Adults With and Without Cancer History in the United States.

PURPOSE OF STUDY: Of 15.5 million US cancer survivors, 80% are ≥ 55 years. Supporting older patients in care self-management through electronic health information (EHI) exchange may enhance recovery. We assessed: (1) perceived importance of EHI access to adults ≥ 55 years (incl survivors) and (2) age-related preferences for EHI exchange. RECENT FINDINGS: Older adults are one of the fastest-growing user groups for internet/technologies. Most older adults 55-64 years are active internet users, and use among adults ≥ 65 years is growing quickly as baby boomers mature. Understanding EHI patient-provider exchange preferences may provide opportunities for older patients but also begin to address the future needs of other patient populations, including cancer survivors. We observed a "digital divide" for perceived importance of EHI access and EHI exchange interests. Engaging older adults (i.e., ≥ 75 years) to improve comfort/experience with technologies may support EHI use in self-management. Survivors may have distinct EHI needs/preferences than older adults without cancer history.

The Impact of Weight and Weight-Related Perceptions on Smoking Status Among Young Adults in a Text-Messaging Cessation Program.

Introduction: Weight gain and concerns about weight can influence a smoker's ability to successfully quit, and young adults are a subgroup of smokers who are particularly concerned about the impact of quitting on their body weight. This study explored the associations between body mass index, weight perceptions, and smoking status among young adults. Methods: The sample consisted of 4027 young adults between the ages of 18 and 29 who participated in a randomized control trial of the National Cancer Institute's SmokefreeTXT program. Multivariable logistic regression models were used to examine the associations between weight related variables and smoking status. Results: Obese participants had a 0.72 lower odds (95% CI: 0.62, 0.85) of reporting smoking at the end of the program than participants of normal weight, and this difference persisted over time. Weight perceptions were also associated with smoking status. Those who perceived themselves to be slightly underweight/underweight were more likely to report smoking than those who reported being just about the right weight (OR: 1.53, 95% CI: 1.20, 1.95), and those who strongly disagreed that smoking cigarettes helps people keep their weight down were less likely to report smoking at the end of treatment than those who neither agreed nor disagreed with this statement (OR: 0.69, 95% CI: 0.54, 0.87). Conclusions: Weight related factors assessed at baseline predicted smoking status at the end of treatment and through long term follow-up. Smoking cessation programs that tailor content to addresses the specific needs of weight concerned smokers may enhance effectiveness. Implications: This study explores the association between weight related factors and smoking status among young adults, a priority population for smoking cessation efforts. This study demonstrates that both actual weight and weight perceptions (eg, perception of body weight, perception of associations between smoking and weight) are associated with smoking outcomes, and thus need to be a considered in the development of smoking cessation programs.

Cigarette smoking risk-reducing beliefs: Findings from the United States Health Information National Trends Survey.

Cigarette smoking risk-reducing beliefs are ideas that certain health promoting behaviors (e.g., exercise) may mitigate the risks associated with smoking. The objective of this study was to describe smoking risk-reducing beliefs and the belief that quitting can reduce the harmful effects of smoking among the U.S. adult population and the associations between these beliefs, current smoking status, and sociodemographics. Data were from the Health Information National Trends Survey 4 (HINTS 4) Cycles 3 and 4 (2013-2014; N=6862). Descriptive analyses were conducted to examine bivariate associations among the quit smoking belief, smoking risk-reducing beliefs, and covariates. Weighted ordinal logistic regression models examined the adjusted associations between smoking status and sociodemographics, with quit smoking belief and risk-reducing beliefs. Eighty-two percent of the population reported that quitting cigarette smoking can help reduce the harmful effects of smoking a lot: former smokers and individuals with higher educational attainment were more likely to endorse this belief than never smokers and those with lower educational attainment. Many people endorsed smoking risk-reducing beliefs about exercise (79.3%), fruits and vegetables (71.8%), vitamins (67.2%), and sleep (68.5%). Former smokers were less likely to subscribe to these beliefs than never smokers. Vulnerable populations who may be most at risk of smoking attributable morbidity and mortality were more likely to endorse risk-reducing beliefs. Future studies are needed to better understand how risk-reducing beliefs are formed and if modifying these beliefs may help to reduce cigarette smoking in the U.S.

Analysing user-reported data for enhancement of SmokefreeTXT: a national text message smoking cessation intervention.

OBJECTIVE: This observational study highlights key insights related to participant engagement and cessation among adults who voluntarily subscribed to the nationwide US-based SmokefreeTXT program, a 42-day mobile phone text message smoking cessation program. METHODS: Point prevalence abstinence rates were calculated for subscribers who initiated treatment in the program (n=18 080). The primary outcomes for this study were treatment completion and point prevalence abstinence rate at the end of the 42-day treatment. Secondary outcomes were point prevalence abstinence rates at 7 days postquit, 3 months post-treatment and 6 months post-treatment, as well as response rates to point prevalence abstinence assessments. RESULTS: Over half the sample completed the 42-day treatment (n=9686). The end-of-treatment point prevalence abstinence for subscribers who initiated treatment was 7.2%. Among those who completed the entire 42 days of treatment, the end-of-treatment point prevalence abstinence was 12.9%. For subscribers who completed treatment, point prevalence abstinence results varied: 7 days postquit (23.7%), 3 months post-treatment (7.3%) and 6 months post-treatment (3.7%). Response rates for abstinence assessment messages ranged from 4.36% to 34.48%. CONCLUSIONS: Findings from this study illuminate the need to more deeply understand reasons for subscriber non-response and opt out and, in turn, improve program engagement and our ability to increase the likelihood for participants to stop smoking and measure long-term outcomes. Patterns of opt out for the program mirror the relapse curve generally observed for smoking cessation, thus highlighting time points at which to increase efforts to retain participants and provide additional support or incentives.

Cancer survivors as activated patients: Exploring the relationship between cancer history and patient activation.

Many cancer survivors experience long-term physical and psychosocial sequalae. As such, there is a need for survivors to be activated and participate in their own health care. Our study explores the relationship between cancer history and patient activation. We used data from the 2013 Health Information National Trends Survey (N = 3185, response rate = 35.19%). Survivors had approximately 70% higher odds of being highly activated compared to those with no cancer history. Level of activation did not vary across time since diagnosis. Future research should examine mechanisms for increased activation in survivors and ways to encourage more activation behaviors.

Mining Health App Data to Find More and Less Successful Weight Loss Subgroups.

BACKGROUND: More than half of all smartphone app downloads involve weight, diet, and exercise. If successful, these lifestyle apps may have far-reaching effects for disease prevention and health cost-savings, but few researchers have analyzed data from these apps. OBJECTIVE: The purposes of this study were to analyze data from a commercial health app (Lose It!) in order to identify successful weight loss subgroups via exploratory analyses and to verify the stability of the results. METHODS: Cross-sectional, de-identified data from Lose It! were analyzed. This dataset (n=12,427,196) was randomly split into 24 subsamples, and this study used 3 subsamples (combined n=972,687). Classification and regression tree methods were used to explore groupings of weight loss with one subsample, with descriptive analyses to examine other group characteristics. Data mining validation methods were conducted with 2 additional subsamples. RESULTS: In subsample 1, 14.96% of users lost 5% or more of their starting body weight. Classification and regression tree analysis identified 3 distinct subgroups: "the occasional users" had the lowest proportion (4.87%) of individuals who successfully lost weight; "the basic users" had 37.61% weight loss success; and "the power users" achieved the highest percentage of weight loss success at 72.70%. Behavioral factors delineated the subgroups, though app-related behavioral characteristics further distinguished them. Results were replicated in further analyses with separate subsamples. CONCLUSIONS: This study demonstrates that distinct subgroups can be identified in "messy" commercial app data and the identified subgroups can be replicated in independent samples. Behavioral factors and use of custom app features characterized the subgroups. Targeting and tailoring information to particular subgroups could enhance weight loss success. Future studies should replicate data mining analyses to increase methodology rigor.

Social Network Behavior and Engagement Within a Smoking Cessation Facebook Page.

BACKGROUND: Social media platforms are increasingly being used to support individuals in behavior change attempts, including smoking cessation. Examining the interactions of participants in health-related social media groups can help inform our understanding of how these groups can best be leveraged to facilitate behavior change. OBJECTIVE: The aim of this study was to analyze patterns of participation, self-reported smoking cessation length, and interactions within the National Cancer Institutes' Facebook community for smoking cessation support. METHODS: Our sample consisted of approximately 4243 individuals who interacted (eg, posted, commented) on the public Smokefree Women Facebook page during the time of data collection. In Phase 1, social network visualizations and centrality measures were used to evaluate network structure and engagement. In Phase 2, an inductive, thematic qualitative content analysis was conducted with a subsample of 500 individuals, and correlational analysis was used to determine how participant engagement was associated with self-reported session length. RESULTS: Between February 2013 and March 2014, there were 875 posts and 4088 comments from approximately 4243 participants. Social network visualizations revealed the moderator's role in keeping the community together and distributing the most active participants. Correlation analyses suggest that engagement in the network was significantly inversely associated with cessation status (Spearman correlation coefficient = -0.14, P=.03, N=243). The content analysis of 1698 posts from 500 randomly selected participants identified the most frequent interactions in the community as providing support (43%, n=721) and announcing number of days smoke free (41%, n=689). CONCLUSIONS: These findings highlight the importance of the moderator for network engagement and provide helpful insights into the patterns and types of interactions participants are engaging in. This study adds knowledge of how the social network of a smoking cessation community behaves within the confines of a Facebook group.

Identity reconstruction among older cancer survivors: Age and meaning in the context of a life-altering illness.

This article evaluates how older cancer patients describe cancer survivorship and incorporate the cancer experience into long-term evaluations of health. From a series of 53 qualitative interviews with adults with histories of breast and prostate cancers and non-Hodgkin's lymphoma, we analyzed age-related discussions among those 65 and older (n = 21). Emergent themes revealed the: (1) historical conceptualization of cancer, (2) changed perspective following diagnosis, (3) cancer in the context of a long biography, (4) cancer in the context of the aging body and decline, and (5) meaning of time remaining and quality of life. One important suggestion from our work, relevant to all clinicians regardless of specialty or role, is to incorporate goals for the future into individualized survivor care plans for older survivors.

Muscular Grip Strength Estimates of the U.S. Population from the National Health and Nutrition Examination Survey 2011-2012.

The purposes of this study were to use the National Health and Nutrition Examination Study (2011-12) data to determine nationally representative combined handgrip strength ranges and percentile information by sex and age group, examine trends in strength across age by sex, and to determine the relative proportion of children and adults falling into established health benefit zones (HBZ). Results indicate that mean strength was greater among men than women and increased linearly for children and in a quadratic fashion among adults for both sexes. Grip strength peaked in the 30- to 39-year age group for both men (216.4 lbs) and women (136.5 lbs) with subsequent age groups showing gradual decline, p < 0.0001. Relative and absolute increases in grip strength were greater for men than for women, but relative decrease from peak strength was less among women than men. Although absolute strength was greater among men than women, HBZ data indicated that a higher percentage of men than women overall and at each age group fell into the needs improvement zone, with differences particularly pronounced during adolescence and older adulthood. These data provide the first nationally representative population estimates of combined handgrip strength and percentile information from childhood through senescence and suggest consideration of HBZ information in conjunction with grip strength to improve surveillance data interpretation and intervention planning.

The impact of cancer treatment on the diets and food preferences of patients receiving outpatient treatment.

Patients undergoing cancer treatment experience a multitude of symptoms that can influence their ability to complete treatment as well as their quality of life during and after treatment. This cross-sectional study sought to describe the dietary changes experienced by cancer patients and to identify associations between these changes and common treatment symptoms. A convenience sample of 1199 cancer patients aged 18 yr and older undergoing active treatment were recruited from 7 cancer centers to complete a self-administered paper-and-pencil survey. Descriptive analyses were conducted to estimate prevalence of dietary changes and chi-squared tests were used to examine associations between dietary changes and health outcomes. Approximately 40% of patients reported a decreased appetite since beginning treatment, and 67.2% of patients reported at least 1 chemosensory alteration. Increased taste sensitivities were more common than decreased taste sensitivities, with increased sensitivity to metallic being the most common taste sensitivity (18.6%). Patients also had increased sensitivities to certain smells including cleaning solutions (23.4%), perfume (22.4%), and food cooking (11.4%). Patients reported a wide range of food preferences and aversions. Patients who had less energy or lost weight since beginning treatment were more likely than others to report treatment-related dietary changes.

Capitalizing on the "teachable moment" to promote healthy dietary changes among cancer survivors: the perspectives of health care providers.

PURPOSE: Although cancer is often thought of as a teachable moment, many cancer survivors do not adhere to behavioral recommendations that might improve their health. This study explored health care providers' perspectives on the importance and feasibility of addressing behavior change, specifically healthy diet, with cancer survivors. METHODS: In-depth interviews were conducted with 33 health care providers who care for posttreatment survivors of breast cancer, prostate cancer, and non-Hodgkin's lymphoma. Interviews were analyzed thematically. RESULTS: Health care providers emphasized the strength of evidence linking diet/obesity to recurrence in their assessment of the importance of promoting dietary change among their survivor patients. Cancer specialists (e.g., oncologists, surgeons) generally brought up dietary change with patients if they considered the evidence to be strong. In contrast, primary care providers viewed health promotion as important for all patients and reported treating cancer survivor patients the same as others when it came to making dietary recommendations. There was a lack of consensus among providers on the best timing to bring up behavior change. Providers described specific subgroups of patients who they saw as more motivated to make behavior changes and patient barriers to making dietary changes. CONCLUSIONS: Health care providers can play an important role in promoting healthy diet among cancer survivors. As the evidence base around diet and cancer recurrence/prognosis grows, it is important that this information is communicated to providers. Strategies such as incorporating behavior change messages into survivor care plans may help standardize recommendations to survivors.

Race, Social and Environmental Conditions, and Health Behaviors in Men.

Although understanding race differences in health behaviors among men is an important step in reducing disparities in leading causes of death in the United States, progress has been stifled when using national data because of the confounding of race, socioeconomic status, and residential segregation. The purpose of this study is to examine the nature of disparities in health behaviors among African American and white men in the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore, which was conducted in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. After adjusting for age, marital status, insurance, income, educational attainment, poor or fair health, and obesity status, African American men in National Health Interview Survey had greater odds of being physically inactive (odds ratio [OR] = 1.48; 95% confidence interval [CI], 129-1.69), reduced odds of being a current smoker (OR = 0.77; 95% CI, 0.65-0.90), and reduced odds of being a current drinker (OR = 0.58; 95% CI, 0.50-0.67). In the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore sample, African American and white men had similar odds of being physically inactive (OR = 0.79; 95% CI, 0.50-1.24), being a current smoker (OR = 0.86; 95% CI, 0.60-1.23), or being a current drinker (OR = 1.34; 95% CI, 0.81-2.21). Because race disparities in these health behaviors were ameliorated in the sample where African American and white men were living under similar social, environmental, and socioeconomic status conditions, these findings suggest that social environment may be an important determinant of health behaviors among African American and white men. Public health interventions and health promotion strategies should consider the social environment when seeking to better understand men's health disparities.

Exploring important influences on the healthfulness of prostate cancer survivors' diets.

A cancer diagnosis is often conceptualized as a teachable moment when individuals might be motivated to make lifestyle changes. Many prostate cancer survivors, however, do not adhere to dietary guidelines. In this article, we explore how cancer affected prostate cancer survivors' diets and identify important influences on diet. Twenty prostate cancer survivors completed three 24-hour dietary recalls and an in-depth dietary interview. We analyzed interviews using a constant comparison approach, and dietary recall data quantitatively to assess quality and qualitatively to identify food choice patterns. Most men reported not making dietary changes following their cancer diagnosis but did express an interest in healthy eating, primarily to facilitate weight loss. Men portrayed barriers to healthy eating that often outweighed their motivation to eat healthy. Public health programs should consider alternative ways of framing healthy eating programs for prostate cancer survivors that might be more effective than a cancer-specific focus.

Key considerations in designing a patient navigation program for colorectal cancer screening.

Colorectal cancer is the second leading cause of cancer mortality among those cancers affecting both men and women. Screening is known to reduce mortality by detecting cancer early and through colonoscopy, removing precancerous polyps. Only 58.6% of adults are currently up-to-date with colorectal cancer screening by any method. Patient navigation shows promise in increasing adherence to colorectal cancer screening and reducing health disparities; however, it is a complex intervention that is operationalized differently across institutions. This article describes 10 key considerations in designing a patient navigation intervention for colorectal cancer screening based on a literature review and environmental scan. Factors include (1) identifying a theoretical framework and setting program goals, (2) specifying community characteristics, (3) establishing the point(s) of intervention within the cancer continuum, (4) determining the setting in which navigation services are provided, (5) identifying the range of services offered and patient navigator responsibilities, (6) determining the background and qualifications of navigators, (7) selecting the method of communications between patients and navigators, (8) designing the navigator training, (9) defining oversight and supervision for the navigators, and (10) evaluating patient navigation. Public health practitioners can benefit from the practical perspective offered here for designing patient navigation programs.

User Experiences With an SMS Text Messaging Program for Smoking Cessation: Qualitative Study.

BACKGROUND: Mobile health strategies for smoking cessation (eg, SMS text messaging-based interventions) have been shown to be effective in helping smokers quit. However, further research is needed to better understand user experiences with these platforms. OBJECTIVE: This qualitative study aims to explore the experiences of real-world users of a publicly available smoking cessation program (SmokefreeTXT). METHODS: Semistructured phone interviews were conducted with 36 SmokefreeTXT users between March and July 2014. Of these 36 participants, 50% (18/36) of participants completed the SmokefreeTXT program (ie, did not opt out of the program before the 6- to 8-week completion period), and 50% (18/36) did not complete the program (ie, requested to opt out of the program before the completion period). Interview questions focused on smoking behaviors, quitting history, opinions on the program's content and structure, answering assessment questions, using keywords, reasons for opting out, and perceived usefulness of the program for quitting smoking. A thematic content analysis was conducted, with a focus on themes to increase program engagement and optimization. RESULTS: The findings highlighted features of the program that participants found beneficial, as well as some elements that showed opportunities for improvement to boost program retention and successful cessation. Specifically, most participants found the SmokefreeTXT program to be convenient and supportive of cessation; however, some found the messages to be repetitive and reported a desire for more flexibility based on their readiness to quit and cessation progress. We also found that program completion did not necessarily indicate successful smoking cessation and that program opt out, which might be interpreted as a less positive outcome, may occur because of successful cessation. Finally, several participants reported using SmokefreeTXT together with other evidence-based cessation methods or non-evidence-based strategies. CONCLUSIONS: Qualitative interviews with real-world SmokefreeTXT users showed high program acceptability, engagement with program features, and perceived utility for smoking cessation. Our findings directly informed several program updates, such as adding an adaptive quit date feature and offering supplemental information on live support services for users who prefer human interaction during the cessation process. The study has implications for other digital tobacco cessation interventions and highlights important topics that warrant future research, such as the relationship between program engagement (eg, opt out and retention) and successful cessation.

Assessment of and Interventions for Women at High Risk for Breast or Ovarian Cancer: A Survey of Primary Care Physicians.

As clinical guidelines for cancer prevention refer individuals to primary care physicians (PCP) for risk assessment and clinical management, PCPs may be expected to play an increasing role in cancer prevention. It is crucial that PCPs are adequately supported to assess an individual's cancer risk and make appropriate recommendations. The objective of this study is to assess use, familiarity, attitude, and behaviors of PCPs regarding breast and ovarian cancer risk and prevention, to better understand the factors that influence their prescribing behaviors. We conducted a cross-sectional, web-based survey of PCPs in the United States, recruited from an opt-in healthcare provider panel. Invitations were sent in batches until the target sample size of 750 respondents (250 each for obstetrics/gynecology, internal medicine, and family medicine) was met. Self-reported use of breast/ovarian cancer risk assessments was low (34.7%-59.2%) compared with discussion of cancer family history (96.9%), breast exams (87.1%), and mammograms (92.8%). Although most respondents (48.0%-66.8%) were familiar with cancer prevention interventions, respondents who reported to be less familiar were more likely to report cautious attitudes. When presented with hypothetical cases depicting patients at different breast/ovarian cancer risks, up to 34.0% of respondents did not select any of the clinically recommended course(s) of action. This survey suggests that PCP use of breast/ovarian cancer risk assessment tools and ability to translate the perceived risks to clinical actions is variable. Improving implementation of cancer risk assessment and clinical management guidelines within primary care may be necessary to improve the appropriate prescribing of cancer prevention interventions.Prevention Relevance: Primary care physicians are becoming more involved in cancer prevention management, so it is important that cancer risk assessment and medical society guideline recommendations for cancer prevention are better integrated into primary care to improve appropriate prescribing of cancer prevention interventions and help reduce cancer risk.