If we accurately perceive our risk of a future problem, then it follows that we would implement behaviours to try to protect ourselves from this risk.

For example, if we perceive that wearing a seat belt reduces the risk of serious injury in a car accident, then we are more likely to wear it. Does this translate to other areas of our health?

If we perceive that we are at risk of cancer from smoking, do we stop smoking? Not always.

Women and Risk Perception

Research shows that women do not accurately perceive their risk of disease and ill health.

In a recent Australian study, 27% of women perceived breast cancer a health risk, while 11% perceived cardiovascular disease (CVD) a risk, compared to mortality rates of 3% and 46% respectively.^1-4

Rates of diabetes are increasing rapidly in Western societies, yet do women accurately perceive their risk of type 2 diabetes if they have polycystic ovary syndrome or gestational diabetes or if they are obese?

Answers to these questions are important given that diabetes significantly increases women's CVD risk.^5-6

What Influences Risk Perception?

We evaluate risk depending on certain criteria. Problem-solving skills rely very much on intellectual ability and on how the numbers are presented to us.

The bigger the numbers, the higher the risk - right? Not always. Emotional and affective reactions also enter our calculations and may mean we fear the wrong things.

In a study that involved choosing the greater chance of getting a coloured bean in a bowl of white jelly beans, low numerate participants were more likely to choose a bowl that had nine coloured jelly beans in a bowl of 100 (9% chance) compared to one coloured jelly bean in a bowl of 10 (10% chance).¹⁰ Nine and 100 seemed much bigger numbers, thereby a greater chance, even though likelihood was higher in the jar of 10.

Generally people have difficulty determining risk and get confused by different terms used such as absolute, lifetime or relative risk, as well as the emotion that may be attached to the risk.

The most effective way to communicate risk is on an individual level in a discussion between practitioner and patient.^11-12

Breast Cancer Versus CVD

To illustrate the dilemma of risk perception, consider the perceptions women have of their risk for breast cancer and CVD based on evaluation criteria.

Outcome: If women perceive a worse outcome for breast cancer than CVD, then they are more likely to fear it. In 2004, 26,306 women died of CVD, while 2500 die from breast cancer each year.^2,13

Women should continue to perceive breast cancer as an important risk while more accurately understanding their risk from CVD.

Fifty per cent of myocardial infarcts (MI) in women are unrecognised compared to 33% for men, and 38% of women die in the first year after unrecognised MI compared to 25% of men.^14-15

A woman younger than 55 is 6.7 times less likely to be hospitalised than men for CVD symptoms.¹⁶ The outcome for CVD for women is poor, yet it is not well communicated or understood by women.

Chance: Do men have a greater chance of CVD than women? When age-standardised data are considered, CVD is more prevalent in women (20.8%) than in men (18.5 per cent).²

Alarmingly, 90% of women (and men) have risk factors for CVD (smoking, diet, high cholesterol etc), yet we are unclear as to how women view these risk factors. Only 38% of doctors in the US discuss coronary heart disease with women.⁴ As women age, the risk of CVD is significant.

Time: The thought of breast cancer is more immediate for women, while CVD may be something to worry about when they are older. Women are encouraged to do monthly breast examinations, have regular mammograms and when a lump is discovered action is immediate.

However, we need to improve cardiovascular checks also and begin at a younger age. Even on discharge from a coronary event, fewer women were found to be given information on diet, weight and medication than men.¹⁵ Perhaps when we are younger, we perceive that we will be able to reverse any damage to our health from our younger years - we believe we "still have time".

Emotions play a part in risk perception. Breasts are an important part of female anatomy and there is an affective reaction to breast cancer. Heart disease does not appear to have the same emotional connection yet, perhaps because it is portrayed as more of a male disease.

Summary

Changing lifestyle habits to improve health is very difficult to do. Perhaps we need to start by increasing the knowledge base of women, particularly around the risk evaluation criteria of outcome and chance.

Women should perceive breast cancer as an important risk to motivate appropriate health behaviours, including prevention and screening, but they should also more accurately perceive their risk of CVD and diabetes.

 Talking Women - The realities of risk perception (156.20 KB)

References

Content Updated October 1, 2008