title: Health care utilization, lifestyle, and emotional factors and mammography practices in the Childhood Cancer Survivor Study.
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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  Screening encounters could be used to promote mammography compliance in this population.
authors: Harvard School of Public Health, Boston, Massachusetts. Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Shoshana M
authors: SM
authors: Rosenberg
authors: Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Chaya S
authors: CS
authors: Moskowitz
authors: Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Jennifer S
authors: JS
authors: Ford
authors: University of Chicago, Chicago, Illinois.
authors: Tara O
authors: TO
authors: Henderson
authors: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: A Lindsay
authors: AL
authors: Frazier
authors: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Lisa R
authors: LR
authors: Diller
authors: St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Melissa M
authors: MM
authors: Hudson
authors: University of California, Los Angeles, California.
authors: Annette L
authors: AL
authors: Stanton
authors: Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Joanne F
authors: JF
authors: Chou
authors: Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Stephanie
authors: S
authors: Smith
authors: Fred Hutchison Cancer Research Center, Seattle, Washington.
authors: Wendy M
authors: WM
authors: Leisenring
authors: Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia.
authors: Ann C
authors: AC
authors: Mertens
authors: St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Cheryl L
authors: CL
authors: Cox
authors: Hospital for Sick Children, University of Toronto, Canada.
authors: Paul C
authors: PC
authors: Nathan
authors: St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Kevin R
authors: KR
authors: Krull
authors: St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Leslie L
authors: LL
authors: Robison
authors: Memorial Sloan Kettering Cancer Center, New York, New York. oeffingk@mskcc.org.
authors: Kevin C
authors: KC
authors: Oeffinger
mesh_terms: D000328:Adult; D000367:Age Factors; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology; D002648:Child; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008019:Life Style; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D065006:Papanicolaou Test / Q000706:statistics & numerical data; D016012:Poisson Distribution; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data