 individual level of risk black women are also less likely to do that and then for people at particularly high risk there are options that are preventive surgeries and preventive medications and again our study finds like others that african-american women are less likely to do those things so those are kind of the decisions and then the really unique thing about our study is that we were able to dive much deeper because we had in-depth qualitative conversations with women to understand how women make those kinds of choices