Health Care Utilization, Lifestyle, and Emotional Factors and Mammography Practices in the Childhood Cancer Survivor Study

• Type of Material: Article
• Authors: Shoshana M. Rosenberg, Harvard University; Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center; Jennifer S. Ford, Memorial Sloan Kettering Cancer Center; Tara O. Henderson, University of Chicago; A. Lindsay Frazier, Dana-Farber Cancer Institute; Lisa R. Diller, Dana-Farber Cancer Institute; Melissa M. Hudson, St Jude Children’s Research Hospital; Annette L. Stanton, University of California Los Angeles; Joanne F. Chou, Memorial Sloan Kettering Cancer Center; Stephanie Smith, Memorial Sloan Kettering Cancer Center; Wendy M. Leisenring, Memorial Sloan Kettering Cancer Center; Ann Mertens, Emory University; Cheryl L. Cox, St Jude Children’s Research Hospital; Paul C. Nathan, University of Toronto; Kevin R. Krull, St Jude Children’s Research Hospital; Leslie L. Robison, St Jude Children’s Research Hospital; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center
• Language: English
• Date: 2015-11-01
• Publisher: American Association for Cancer Research
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 AACR.
• Final Published Version (URL): http://dx.doi.org/10.1158/1055-9965.EPI-14-1377
• Title of Journal or Parent Work: Cancer Epidemiology, Biomarkers and Prevention
• ISSN: 1055-9965
• Volume: 24
• Issue: 11
• Start Page: 1699
• End Page: 1706
• Grant/Funding Information: This work was also conducted with support from The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award 8UL1TR000170-05 and financial contributions from Harvard University and its affiliated academic health care centers).; National Cancer Institute: U24CA55727; R21CA106972, K05CA160724 and R01CA134722 (PI: Oeffinger KC); R01CA136783 and Memorial Sloan Kettering Core Grant Core Grant P30 CA008748 (PI: Moskowitz CS); R25CA05771 and R25CA9220 (Rosenberg SM).
• Keywords: OVARIAN-CANCER; BRIEF SYMPTOM INVENTORY-18; YOUNG-ADULT CANCER; Oncology; Science & Technology; SCREENING MAMMOGRAPHY; CHEST RADIATION; FAMILY-HISTORY; FOLLOW-UP; Life Sciences & Biomedicine; BODY-MASS INDEX; BREAST-CANCER; Public, Environmental & Occupational Health; HODGKINS-DISEASE
• Research Categories: Health Sciences, General; Health Sciences, Oncology; Health Sciences, Public Health

Abstract

Background: Women with a history of chest radiotherapy have an increased risk of breast cancer; however, many do not undergo annual recommended screening mammography. We sought to characterize the relationship between mammography and potentially modifiable factors, with the goal of identifying targets for intervention to improve utilization. Methods: Of 625 female participants sampled from the Childhood Cancer Survivor Study, who were treated with chest radiotherapy, 551 responded to a survey about breast cancer screening practices. We used multivariate Poisson regression to assess several lifestyle and emotional factors, health care practices, and perceived breast cancer risk, in relation to reporting a screening mammogram within the last two years. Results: Women who had a Papanicolaou test [prevalence ratio (PR):1.77; 95% confidence interval (CI) 1.26-2.49], and who perceived their breast cancer risk as higher than the average woman were more likely to have had a mammogram (PR, 1.26; 95% CI, 1.09-1.46). We detected an attenuated effect of echocardiogram screening [PR, 0.70; 95% CI (0.52-0.95)] on having a mammogram among older women compared with younger women. Smoking, obesity, physical activity, coping, and symptoms of depression and somatization were not associated with mammographic screening. Conclusion: Our findings suggest that compliance with routine and risk-based screening can be an important indicator of mammography in childhood cancer survivors. In addition, there is a need to ensure women understand their increased breast cancer risk, as a means to encouraging them to follow breast surveillance guidelines. Impact: Screening encounters could be used to promote mammography compliance in this population.