Mammography Adherence among High-Risk Women with Breast Cancer and Either a Non-Pathogenic Mutation Identified or Untested BRCA1/2 Genetic Status

Abstract

Background: Little is known about the illness perceptions of women with a previous breast cancer diagnosis and either no access to a personal BRCA1/2 test or tested and a no pathogenic mutation identified result and how this might impact their mammography adherence. Objective: The aim of this study was to assess the impact of illness beliefs, specifically those relating to emotional representations and cure and control beliefs about breast cancer, and socio-economic status (SES) on mammography adherence of these women. The traditional health belief model (HBM) was compared to a modified model which allowed for the contribution of emotions in health surveillance decision-making. Method: Mailed self-report questionnaires were completed by 193 women recruited from an Australian Familial Cancer Centre. Step-wise logistic regression analyses were conducted on n=150 [aged 27-89 years (M=56.9)] for whom complete data were available. Results: The questionnaire response rate was 36%. Higher levels of emotional representations of breast cancer were associated with greater mammography adherence (OR = 1.18, 95% CI = 1.03-1.36, p =.019). Middle income was six times more likely to predict mammography adherence than lower income (OR = 6.39, 95% CI = 1.03 – 39.63, p =.047). The modified HBM was superior to the traditional HBM in predicting mammography adherence (X2 [15, N = 118] = 26.03, p =.038). Conclusions: Despite a modest response rate, our data show that emotional illness representations about breast cancer and middle income status were found to significantly predict mammography adherence. Therefore, providing surveillance services and delivering information considerate of financial status and constructed around emotional motivators may facilitate mammography adherence among women like those described in this study.

Use of breast surveillance between women with pathogenic variants and variants of uncertain significance in breast cancer susceptibility genes

“…Survivors of sporadic breast cancer who have not undergone bilateral mastectomy and are recommended to undergo mammographic surveillance report substantial underutilization of surveillance. 3,4 Similar underutilization is also reported among BRCA1/2-positive women, where US studies have reported that rates of mammography adherence range between 59%-81% [5][6][7] in the year after genetic testing. In one study, women with VUS were less likely to undergo surveillance in the Cancer October 15, 2022 first year after testing compared to those with a deleterious mutation, 8 whereas another study found no difference in risk management between women with BRCA1/2-positive and VUS results.…”