title: 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.
authors.affiliation: Department of Hematology and Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, Melbourne, Victoria, 8006, Australia.
authors.forename: Yoland C
authors.initials: YC
authors.lastname: Antill
authors.forename: John
authors.initials: J
authors.lastname: Reynolds
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Young
authors.forename: Judy A
authors.initials: JA
authors.lastname: Kirk
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Tucker
authors.forename: Tarli L
authors.initials: TL
authors.lastname: Bogtstra
authors.forename: Shirley S
authors.initials: SS
authors.lastname: Wong
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Dudding
authors.forename: Juliana L
authors.initials: JL
authors.lastname: Di Iulio
authors.forename: Kelly-Anne
authors.initials: KA
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D016504:Breast Self-Examination; D018394:CA-125 Antigen / Q000097:blood; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D010349:Patient Compliance; D012306:Risk
chemical_list: D018394:CA-125 Antigen