Screening behavior in women at increased familial risk for breast cancer

Abstract

This multicenter study examined the adherence of high-risk women to screening recommendations for breast and ovarian cancer following consultation at a familial cancer clinic (FCC). Self-report questionnaires assessing recall of screening advice, tests undertaken, risk perception, anxiety (Impact of Events Scale) and demographics were mailed to 396 consecutive eligible women who had attended one of six FCCs a median of 3.6 years prior. Family history, genetic test results and screening recommendations were abstracted from medical records. 182/266 (68.4%) women responded with 130 lost to follow-up. The proportions of women undertaking at least the recommended frequency of screening tests were: breast self examination (BSE) 50.4%, clinical breast examination (CBE) 66.0%, mammography 82.2%, transvaginal ultrasound (TVUS) 70.0%, CA125 84.0%. Factors associated with adherence to screening were: higher anxiety for BSE and CBE, being BRCA1/2 positive for CBE, older age, method of arrangement and having at least one affected first degree relative for mammography. Factors significantly associated with over-adherence were higher scores for anxiety for BSE and CBE and younger age (< 40 years) for TVUS. Between 41.3% (BSE) and 57.6% (CBE) of women incorrectly recalled their screening recommendations. A substantial minority of high-risk women do not adhere to screening advice. Strategies to improve the accuracy of recall of recommendations and the uptake of recommended screening are required.

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

“…These percentages are comparable with rates reported by previous studies, which show that between 50 and 89% of women had mammography screening according to age-specific guidelines [8,[22][23][24][25][26]. In contrast, the rate of 45% of high-risk women screening according to guidelines for CBE found in a Of the 8 women with no first-and second-degree relatives with breast cancer, 4 were BRCA1/2 positive and 4 had a family history of ovarian cancer b BRCA1/2 mutation negative (in the setting of a known mutation in the family) women excluded from study c Received personal BRCA1/2 mutation result from clinical testing this study is slightly lower than that reported in previous studies (21-87% of high-risk women) [8,24]. It is possible that lower rates of screening with CBE compared to mammography screening and of recommendations for such screening reflect physicians' beliefs that CBE has lower clinical utility compared to mammographic screening.…”

“…It is well documented that adherence to such guidelines is imperfect [2,[7][8][9], with mammogram adherence rates reported to be between 35 and 82% [7,8]. Understanding the barriers and facilitators of screening attendance is critical, if successful interventions to optimize screening practices, and therefore earlier detection and potentially better outcomes of women with a strong family history are to be developed.…”

The relationship between knowledge of family history and cancer characteristics at diagnosis in women newly-diagnosed with invasive breast cancer

“…Similarly, Cohen et al [21], reported that a positive family history in first degree relatives was associated with higher use of mammography. In an Australian study, adherence to mammography screening was found to be 56.5, 66.7 and 91.3% for women with 0, 1 or C2 affected first degree relatives, respectively [26]. Figueiredo et al observed that mammography use was higher amongst women with at least one-first degree relative with breast or ovarian cancer, which they argued was consistent with their observation that these women were more likely to be diagnosed with small cancers, although adjustment for age in their study made the relationship with cancer size not statistically significant [27].…”

The impact of family history of breast cancer and cancer death on women's mammography practices and beliefs

“…In general, studies have found that a family history of breast cancer predicts mammography adherence but may not predict adherence to other screening methods such as clinical breast exam 3,[7][8][9][10] . de Bock et al 11 found that low compliance with mammography recommendations in women with a family history of breast cancer may be related to a lack of confidence in surveillance and failure to remember to do preventive screening activities.…”