title: Prospective study of factors predicting adherence to surveillance mammography in women treated for breast cancer.
abstract: OBJECTIVE
  This prospective study examined the factors that predicted sustained adherence to surveillance mammography in women treated for breast cancer.
  
  
  METHODS
  Breast cancer survivors (N = 204) who were undergoing surveillance mammography completed questionnaires assessing mammography-related anticipatory anxiety, persistent breast pain, mammography pain, and catastrophic thoughts about mammography pain. Adherence to mammography in the following year was assessed.
  
  
  RESULTS
  In the year after study entry, 84.8% of women (n = 173) returned for a subsequent mammogram. Unadjusted associations showed that younger age, shorter period of time since surgery, and having upper extremity lymphedema were associated with lower mammography adherence. Forty percent of women reported moderate to high levels of mammography pain (score of ≥ 5 on a 0 to 10 scale). Although mammography pain was not associated with adherence, higher levels of mammography-related anxiety and pain catastrophizing were associated with not returning for a mammogram (P < .05). The impact of anxiety on mammography use was mediated by pain catastrophizing (indirect effect, P < .05).
  
  
  CONCLUSIONS
  Findings suggest that women who are younger, closer to the time of surgery, or have upper extremity lymphedema may be less likely to undergo repeated mammograms. It may be important for health professionals to remind selected patients directly that some women avoid repeat mammography and to re-emphasize the value of mammography for women with a history of breast cancer. Teaching women behavioral techniques (eg, redirecting attention) or providing medication for reducing anxiety could be considered for women with high levels of anxiety or catastrophic thoughts related to mammography.
authors.affiliation: Duke University Medical Center, Durham, NC 27705, USA. shelb003@mc.duke.edu
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Shelby
authors.forename: Cindy D
authors.initials: CD
authors.lastname: Scipio
authors.forename: Tamara J
authors.initials: TJ
authors.lastname: Somers
authors.forename: Mary Scott
authors.initials: MS
authors.lastname: Soo
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Weinfurt
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
mesh_terms: D000367:Age Factors; D001007:Anxiety / Q000209:etiology; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000150:complications; D008327:Mammography / Q000523:psychology; D008875:Middle Aged; D008962:Models, Theoretical; D010146:Pain; D010349:Patient Compliance; D011446:Prospective Studies; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013997:Time Factors