Younger Age, Recent Surgery, and Lymphedema Influence Decision for Repeat Mammogram in Breast Cancer Survivors

Breast cancer survivors who are younger, closer to the time of surgery, or have upper-extremity lymphedema may be less likely to undergo repeat mammography, new data suggest.

Rebecca A. Shelby, PhD, with Duke University Medical Center in Durham, North Carolina, and colleagues prospectively examined the factors that predicted sustained adherence to surveillance mammography in 204 stage I to IIIA breast cancer survivors who had completed surgery, radiation, and/or chemotherapy within the past two to 10 years. Women who had completed or were receiving adjuvant hormonal therapy were eligible for inclusion in the study.

The investigators said that earlier studies of mammography adherence have focused on women without a history of cancer, and that variables that might influence sustained mammography use in breast cancer survivors may not be the same as variables in women without a cancer history.

Study participants completed questionnaires that assessed anticipatory anxiety about the mammogram, persistent breast pain, mammography pain, and catastrophic thoughts about mammography pain.

A review of medical records showed that 173 women (84.8%) had a subsequent mammogram during the 12 months after the start of the study.

Forty percent of women reported moderate-to- severe mammography pain on the 10-point Brief Pain Inventory. The study also found that higher levels of anticipatory anxiety and pain catastrophizing were associated with poorer anxiety adherence (P <.05). The impact of anticipatory anxiety on mammography adherence was mediated by pain catastrophizing (indirect effect, P <.05).

Shelby, who is assistant professor of Psychiatry and Behavioral Sciences, and coauthors said that the use of behavioral techniques or anti-anxiety medications may be useful in women with high levels of anxiety or catastrophic thoughts related to mammography. Physicians should also consider reminding some patients about the value of mammography in women with a history of breast cancer.

The authors cautioned that the study’s nonexperimental design means that it is not possible to make “causal attributions about the relationships between anxiety, catastrophizing, and adherence.” In addition, because the study was conducted at a university medical center, the findings may not necessarily apply to community practice.

The authors also noted that their study population was followed by oncologists. Earlier research has shown that breast cancer survivors are more likely to undergo mammography when they are followed by an oncologist than a primary care physician.

Finally, the authors said that it is possible that mammography-related anxiety and catastrophizing might represent women’s level of general anxiety. Future research should determine the impact of general anxiety and mammography-related anxiety on adherence.

Shelby RA, Scipio CD, Somers TJ, et al. Prospective study of factors predicting adherence to surveillance mammography in women treated for breast cancer [published online ahead of print February 13, 2012]. doi: 10.1200/JCO.2010.34.4333. J Clin Oncol. 2012;30(8):813-819.