Room for Improvement: Most Breast Cancer Risk Sites Fall Short in Readability

by Katy Henke

Breast cancer is one of the most well known cancers as well as the leading cause of cancer death in women worldwide (1). In an effort to educate and prevent future breast cancer cases and deaths, online health assessment tools have been created to help women understand their risk for developing breast cancer as well as learn how to reduce or manage their risk. These tools allow individuals to input their own health history and family health history into a calculator that then estimates the risk for developing breast cancer.

A recent publication by faculty members at Washington University School of Medicine highlights that many online tools may not be understandable for all users. In the study, 42 online assessment tools were analyzed using specific suitability and readability criteria, and only 21 percent of websites received a superior rating. In rating the tools, the study looked at website content, writing style, context, layout, subheadings and model behavior. Additionally, all websites were rated based on their readability. Overall, the sites had an average of a 12th grade reading level. The recommended reading level for patient-directed health information is 5th or 6th grade (2).

With these findings, the authors recommended future online assessment tools take into account the broader audience who may be utilizing the online health tools. Over a third of the United States population has limited health literacy (3). And these numbers can vary greatly by income, education, and race/ethnicity. Taking steps to improve the readability and usability of online breast health assessment sites would mean that a broader audience would have the possibility of benefitting from their important messages.

What can be done to improve these assessment tools? The study concluded each tool should feature an overview of the assessment tool and explain its purpose to users, what the user’s cancer risk is, and what the user can do to reduce it. Each online assessment tool should also be written at a 5th grade reading level. This would allow the majority of United States population to understand the content. Additionally, vocabulary should include common words, shorter sentences, and words with fewer syllables. The authors also suggested illustrations and graphics that are friendly and inviting when portraying relevant health information.

To help improve risk communication and reduce the health literacy barrier, breast cancer assessment tools can be reformatted in a more user friendly way. Ideally this will help individuals understand their own breast cancer risk as well as ways to reduce and prevent breast cancer.

For a list of assessment tools rated as “superior,” see table below.

From Table 1; Cortez et al, 2015


  1. Center for Disease Control and Prevention. Breast Cancer Statistics. 2015 Aug 20. 
  2. Friedman D.B., & Hoffman Goetz L. 2006 Jun. A systematic review of readability and comprehension instruments used for print and web-based cancer information. Health Education and Behavior. 33(3): 352-373. DOI: 10.1177/1090198105277329.
  3. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. 2006 Sep. U.S. Department of Education. National Center for Education Statistics, Washington, D.C.

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