Predictors of breast cancer screening behavior in women with a strong family history of the disease

Abstract

This study applied the self-regulation model to examine cognitive and emotional predictors of screening in unaffected women with a strong family history of breast cancer. 748 unaffected female members of an Australian registry of multiple-case breast cancer families formed the sample. Participants completed a baseline psychosocial questionnaire and a screening questionnaire 3 years later. Multinomial logistic regression was employed to determine predictors of under- and over-screening according to national guidelines. At follow-up 16% of women under-screened and 10% over-screened with mammography; 55% under-screened with clinical breast examination (CBE); and 9% over-screened with breast self-examination (BSE). Of the women found screening according to guidelines for mammography 72% reported ever having received specific recommendations for mammography screening from a health professional. Compared to appropriate screeners, under-screeners on mammography were less likely to have received a screening recommendation (as were under-screeners on CBE), were younger and reported lower perceived breast cancer risk, but were at higher relative risk (RR) of breast cancer and were more likely to report elevated depression. Over-screeners on mammography were more likely to be younger and have a lower RR of breast cancer. Over-screeners on BSE reported elevated cancer-specific anxiety, were less likely to be university educated and more likely to have received a recommendation for BSE. Under- and over-screening is common in women with a strong family history of breast cancer. Evaluation of interventions targeting perceived risk of breast cancer, anxiety and depression are needed to ensure women obtain accurate advice from relevant specialists and enact screening recommendations.

Identifying Women's Knowledge about Risk Factors of Breast Cancer and Reasons for Having Mammography

“…Consistent with this finding, other studies also reported that women with a history of breast cancer in the family have more information on breast cancer, susceptibility and awareness of screening tests than other women (Dündar et al, 2006;Tastan et al, 2011). More specifically, Price et al (2010) found that the rate of the women with a history of breast cancer in the family who have had the experience of mammography is 74%. Therefore, these findings suggest that these women have higher levels of information about both breast cancer and related risk factors, and that they much more frequently employ the screening methods.…”

Predicting reattendance at a high-risk breast cancer clinic

“…Age was significant in the multivariate model, and, holding all other variables constant, it was found that each year of increased age was associated with a 7% greater likelihood of reattendance; in fact, likelihood of reattendance doubled with each decade of age. This agrees with the thrust of the literature that older age is predictive of greater reattendance as well as adherence to such breast-cancer screening practices as mammography ((Pakenham et al, 2000;Price et al, 2010;Rahman et al, 2005). We view this as logical because older patients would have more stability and security in their lives, personified by long-term relationships, having children, and more established career patterns.…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

“…Depression reduces adherence to treatment 65,66 and interferes with participation in preventive health care. 67,68 Depression is also associated with important risk factors for physical illness, including sedentary lifestyle, 69 obesity, 70 and cigarette smoking. 71 The pathophysiology of depression appears to be related to other fundamental mechanisms of disease (e.g., MDD shares a complex and bidirectional relationship with obesity and associated metabolic problems 70,72 ) and is associated with immune-inflammatory dysfunctions that are implicated in reduced neural plasticity and neuroprogression.…”