What causes breast cancer? A systematic review of causal attributions among breast cancer survivors and how these compare to expert endorsed risks'. Cancer Causes and Control, vol 25 (7) 2014, pp. 771-785. Copyright (2014) Springer International PublishingSwitzerland. All rights reserved. Please note that any alterations made during the publishing process may not appear in this version.The final publication is available at Springer via http:// dx.doi.org/10.1007/s10552-014-0377-3. psychological. Lifestyle-related attributions such as physical inactivity were coded as internal to the individual and modifiable. By contrast, environmental attributions such as air pollution and occupational hazards were considered external to the individual and fixed or non-modifiable. These characteristics tended to correlate so that internal and unstable attributions such as lifestyle-related factors were considered controllable whereas external attributions were likely to stem from the environment and exhibited lower controllability.Although causal attributions alone will not predict patients' behaviors and explain the complexity of human actions, attribution theory provides a framework for understanding the cognitions that influence healthrelated behaviors. Beliefs that people hold with regards to the cause of their own illness influence their decision to seek help, to adhere to medical treatment and their psychological adjustment, during and after treatment [6,10]. Attribution theory also helps explain affective responses to cancer and ways of coping. In the broader population, the media is another factor that shapes understandings of breast cancer causation among women. For example, media coverage of celebrity diagnoses of breast cancer in young women may have led to underestimation of age as a risk factor [27]. Similarly, reports focused on personal accounts of affected women with a family history of breast cancer may have influenced views that breast cancer is a predominantly genetic disease [28]. Social media, particularly blog posts and discussion posts shared by breast cancer patients themselves, has also become an influential and credible forum for the promulgation of health information [29].The following systematic review serves to comprehensively summarize literature on beliefs that affected women have about the cause of their own breast cancer and contrasts this with expert consensus derived from meta-analyses of various risk factors for breast cancer. Findings of this study may inform psychoeducational interventions which can help affected women develop accurate and adaptive beliefs about the cause of their breast cancer. Methodology Data SourcesThe following PubMed, PsycINFO and Web of Knowledge search was conducted on January 25, 2013:(breast cancer OR breast neoplasm) AND (caus* 1 OR attribute* OR belie* OR attitude OR illness 1 *Search term and its derivatives were used (e.g., cause, causes, causal) Inclusion/Exclusion CriteriaStudies were included in the review if they reported causal attributions or beliefs of...

This study aims to examine the association between cancer causal attributions, fear of cancer recurrence (FCR) and psychological well-being and the possible moderating effect of optimism among women with a previous diagnosis of breast cancer. Participants (N = 314) completed an online self-report assessment of causal attributions for their own breast cancer, FCR, psychological well-being and optimism. Simultaneous multiple regression analyses were conducted to explore the overall contribution of causal attributions to FCR and psychological well-being separately. Hierarchical multiple regression analyses were also utilised to examine the potential moderating influence of dispositional optimism on the relationship between causal attributions and FCR and psychological well-being. Causal attributions of environmental exposures, family history and stress were significantly associated with higher FCR. The attribution of stress was also significantly associated with lower psychological well-being. Optimism did not moderate the relationship between causal attributions and FCR or well-being. The observed relationships between causal attributions for breast cancer and FCR and psychological well-being suggest that the inclusion of causal attributions in screening for FCR is potentially important. Health professionals may need to provide greater psychological support to women who attribute their cancer to non-modifiable causes and consequently continue to experience distress.