Table 3.

Patient-Provider Communication Regarding Breast and Ovarian Cancer and Related Risk

Theme	Supporting quote	Family historya	Race/ethnicity	Age, years	Location
Occurrence of a discussion about breast and ovarian cancer	(c1) “I don’t think it’s necessarily (to talk to a doctor). It’s an uncomfortable topic and there’s just no history (of breast or ovarian cancer) in my family.”	No	General population	18–29	Sacramento
	(c2) “If I had a family history, maybe I would (talk to a doctor about breast or ovarian cancer), but I feel like I don’t think about it as much.”	No	Ashkenazi Jewish	18–29	Chicago
Catalysts to communication	(c3) “Mine happened (conversation with doctor) when my mom got diagnosed, like last year, and like I visited and talked to the doctor more in the last year than ever.”	Yes	African American	18–29	Birmingham
	(c4) “Since I was 16 and my mom got breast cancer and my grandmothers’ had it three times, I ask every year about it. I make them triple check.”	Yes	Ashkenazi Jewish	18–29	New York
	(c5) “I’ve definitely approached my doctor because I know this gene is in my family so… and as I mentioned, I’m supposed to get tested for it.”	Yes	General population	30–44	Phoenix
Barriers to communication	(c6) “I feel like it’s not that I don’t want to (talk to the doctor). I just don’t think about it really.”	No	Ashkenazi Jewish	18–29	Chicago
	(c7) “I figure I’m safe if they don’t bring it up. I see the doctor once a year… everything’s checked.”	Yes	Ashkenazi Jewish	30–44	Chicago
	(c8) “Me… honestly no (I don’t talk to my doctor) ‘cause I don’t wanna hear the answer that I have it.”	Yes	General population	18–29	Sacramento
Topics discussed: clinical breast examination	(c9) “My physician said it’s too early for me to get a mammogram. I’ve never had a mammogram, I’m only 35. I’ve actually been trying to get a mammogram since I was 25. And the first time I asked, they said your breasts are not developed. And I told them, ‘Well, I have a history, it’s a family history of breast cancer’. I want to know, because if you have to cut them off, cut them off, I’m fine. I’m totally fine with that. And they still said ‘No, you have to wait’.”	Yes	African American	30–44	Chicago
	(c10) “And my doctor asked me (family history) and I still didn’t get no testing (clinical breast examination) done from there. I told her (I have family history of breast cancer) and she said I don’t even need a mammogram. That’s what I’m saying, and she knew that I had somebody in my family that had breast cancer, but she didn’t even say I needed to be checked (clinical breast examination).”	Yes	African American	30–44	Birmingham
Topics discussed: family history and hereditary health concerns	(c11) “She (physician) did ask if I was of Ashkenazi descent. I said yes, so she did send me for the Tay-Sachs test. There were a couple of other genetic diseases that if you’re a carrier and your husband is a carrier, then your child will be born with it. But breast cancer and ovarian cancer I think are not part of that discussion.”	No	Ashkenazi Jewish	30–44	New York
	(c12) “I’m kind of like how could I not be told about this by any gynecologist? I mean if there’s some sort of risk factor because of who I am, I should know about it I think.”	No	Ashkenazi Jewish	30–44	New York
	(c13) “I never got anything either. Maybe because I was younger, and I was not looking to bear children yet or anything. They don’t mention it (risk of HBOC or genetic mutation) and my doctor is Jewish too so I’m surprised that she didn’t say anything, because I’ve never heard of this either. If they did offer me tests to see if I am positive or negative, I would take them.”	No	Ashkenazi Jewish	30–44	New York
Tone of discussions and patient satisfaction	(c14) “They’re just like, ‘Oh, you’re OK, you’re still 38’. It pisses me off because it’s like I want to be able to prevent it before it happens. I mean I like her, she’s a nice OB/GYN, but she’s just like, ‘Oh, you don’t have to worry about it’. I’m like, ‘I do worry about it’.”	Yes	General population	30–44	Sacramento
	(c15) “So I don’t think it’s really regarding the insurance. It’s just that we’re younger, and they just disregard the situation in total. Because like a mammogram: yes, they are expensive because not too many young women really come up with breast cancer statistically. So they just disregard us overall.”	Yes	African American	18–29	Chicago
	(c16) “I’ve had conversations with my doctor. Some of these doctors…I honestly feel like they don’t know what they be talking about.”	Yes	African American	18–29	Chicago
	(c17) “I was floored by the reaction I got from the radiologist who just ‘foo-foo’d’ me and told me there was nothing there. Then I went to my other doctor again today, my primary care, and she felt it, and she goes ‘It’s pretty obvious that it’s there, so I don’t know why she didn’t know’. You know, it made me mad because you go in, and you make this appointment, and you take time off work to dedicate to find out and get answers and do what you need to do to ask questions or whatever, and it’s like those are your 15 minutes.”	Yes	General population	30–44	Sacramento
	(c18) “If I feel a pain and something’s wrong with me, or whatever, I call my doctor to make an appointment. You (doctor) can’t see me for three months? I can drop dead in three months. I can drop dead tomorrow. What am I supposed to do? Don’t tell me to go to the emergency room. They’re general. They’re not going to do anything. [the emergency room doctor will say] ‘Make an appointment with your doctor. I did’. It’s not for three months.”	Yes	African American	30–44	Chicago
	(c19) “The problem with that is they only have a certain amount of time for you—period. And if you go in there with a list of questions, [the doctor might say] ‘Well, we’re only here for this one, so we’ll discuss this one. You can come back’. It’s like, ‘Well, I have these other questions’. [the doctor might say] ‘Well, I have other patients. I’m on a time schedule’. So they go with the most severe thing and then move forward.”	Yes	General Population	30–44	Sacramento
Actions taken after HCP discussion and reasons for inaction	(c20) “I always go home [after doctor’s visit] and I share with my husband and we make sure we do the checks and I share it with my sister.”	Yes	African American	30–44	Birmingham
	(c21) “Mm-hmm [received mammograms] My two sisters (the one is 23, and the other one’s 25) and me.”	Yes	African American	18–29	Birmingham
	(c22) “So I follow [the HCP’s] plan, which is probably five to ten years earlier than you would normally do some of these [screening tests for cancer].”	Yes	Ashkenazi Jewish	30–44	Chicago
	(c23) “At the end of our visit, he (doctor) basically just sat me in his room and said, ‘There’s this new test’. This was about four years ago. I guess it was a hot topic then. He gave me a pamphlet and said ‘Would you be interested in taking this? Here’s a form to fill out if you want to go for testing’. I didn’t do anything with it. [The pamphlet mentioned fertility and the predisposition for BRCA gene mutation]. I didn’t want to chop off my boobs. I didn’t want to think about it too much. He’s like ‘You can know, or you cannot know’. I’m like ‘I’ll choose not knowing if I have it or not’.”	No	Ashkenazi Jewish	30–44	New York

^aFamily history refers to any history of breast and ovarian cancer.

HBOC, hereditary breast and ovarian cancer; HCP, healthcare provider.