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Lloyd, Kelly E., Louise H. Hall, Lucy Ziegler, and Samuel G. Smith. "Breast cancer worry in higher-risk women offered preventive therapy: a UK multicentre prospective study." Breast Cancer Research and Treatment 188, no. 3 (2021): 703–12. http://dx.doi.org/10.1007/s10549-021-06183-x.
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Abstract Purpose Women’s worry about developing breast cancer may influence their decision to use preventive therapy. However, the direction of this relationship has been questioned. We prospectively investigated the relationship between breast cancer worry and uptake of preventive therapy. The socio-demographic and clinical factors associated with high breast cancer worry were also investigated. Methods Women at increased risk of developing breast cancer were recruited from clinics across England (n = 408). Participants completed a survey on their breast cancer worry, socio-demographic and clinical factors. Uptake of tamoxifen was recorded at 3 months (n = 258 women, 63.2%). Both primary and sensitivity analyses were conducted using different classifications of low, medium and high worry. Results 39.5% of respondents reported medium breast cancer worry at baseline and 21.2% reported high worry. Ethnic minority women were more likely to report high worry than white women (OR = 3.02, 95%CI 1.02, 8.91, p = 0.046). Women educated below degree level were more likely to report high worry than those with higher education (OR = 2.29, 95%CI 1.28, 4.09, p = 0.005). No statistically significant association was observed between worry and uptake. In the primary analysis, fewer respondents with medium worry at baseline initiated tamoxifen (low worry = 15.5%, medium = 13.5%, high = 15.7%). In the sensitivity analysis, participants with medium worry reported the highest uptake of tamoxifen (19.7%). Conclusions No association was observed between worry and uptake, although the relationship was affected by the categorisation of worry. Standardised reporting of the classification of worry is warranted to allow transparent comparisons across cohorts.
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Zhang, Li Rita, Anna M. Chiarelli, Gord Glendon, et al. "Worry Is Good for Breast Cancer Screening: A Study of Female Relatives from the Ontario Site of the Breast Cancer Family Registry." Journal of Cancer Epidemiology 2012 (2012): 1–9. http://dx.doi.org/10.1155/2012/545062.
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Background. Few prospective studies have examined associations between breast cancer worry and screening behaviours in women with elevated breast cancer risks based on family history.Methods. This study included 901 high familial risk women, aged 23–71 years, from the Ontario site of the Breast Cancer Family Registry. Self-reported breast screening behaviours at year-one followup were compared between women at low (N=305), medium (N=433), and high (N=163) levels of baseline breast cancer worry using logistic regression. Nonlinear relationships were assessed using likelihood ratio tests.Results. A significant non-linear inverted “U” relationship was observed between breast cancer worry and mammography screening (P=0.034) for all women, where women at either low or high worry levels were less likely than those at medium to have a screening mammogram. A similar significant non-linear inverted “U” relationship was also found among all women and women at low familial risk for worry and screening clinical breast examinations (CBEs).Conclusions. Medium levels of cancer worries predicted higher rates of screening mammography and CBE among high-risk women.
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Wallner, Lauren P., Nancy K. Janz, Yun Li, et al. "Worry about recurrence and patient preferences for provider roles in collaborative breast cancer care." Journal of Clinical Oncology 35, no. 8_suppl (2017): 158. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.158.
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158 Background: Prior studies have shown that worry about recurrence is a common problem during cancer treatment and survivorship and may be associated with symptom response and surveillance after primary treatment. However, whether worry about recurrence influences patient preferences for which provider to see for their continuing care remains unknown. Methods: A random sample of patients newly diagnosed with breast cancer in 2014-15 as reported to the Georgia and Los Angeles SEER registries were surveyed approximately 6 months after diagnosis (N = 2,502, 70% response rate). Frequency of worry about recurrence was defined by asking women to indicate on a 5-pt scale how often they worried about their cancer coming back in the past month (not at all-always) and was then dichotomized as frequent worry (sometimes/often/almost always) vs. less worry (almost never/rarely). Patient preferences for which provider manages certain aspects of care after treatment were ascertained for: follow-up mammograms, screening for other cancers, general preventive care, and treatment of comorbidities. Response categories included primary care clinician (PCP), cancer doctors, either or both. The associations between patient-reported worry about recurrence with preferences for provider roles were assessed using multinomial logistic regression. Results: In this sample, 37% of women reported worrying frequently about recurrence. Controlling for patient and clinical factors, women who reported more frequent worry (vs. less worry) were more likely to prefer to see both clinicians (vs. PCP only) for mammograms (OR: 2.3, 95%CI: 1.5, 3.6), screening for other cancers (OR: 2.3, 95%CI: 1.5, 3.5), general preventive care (OR: 1.6, 95%CI: 1.1, 2.3) and comorbidity care (OR: 1.5, 95%CI: 1.03, 2.2). Conclusions: Frequent worry about recurrence was common in this sample of women with favorable prognosis breast cancer. More frequent worry about breast cancer recurrence was associated with stronger preferences for seeing both PCPs and oncologists for continuing care after treatment. Assessing and managing worry about recurrence early in survivorship may improve collaborative cancer care and reduce duplicated services after treatment.
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Katz, Steven J., Kevin C. Ward, Ann S. Hamilton, Paul Abrahamse, Sarah T. Hawley, and Allison W. Kurian. "Association of Germline Genetic Test Type and Results With Patient Cancer Worry After Diagnosis of Breast Cancer." JCO Precision Oncology, no. 2 (November 2018): 1–8. http://dx.doi.org/10.1200/po.18.00225.
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Background There are concerns that multigene panel testing compared with BRCA1/2-only testing after diagnosis of breast cancer may lead to unnecessary patient worry about cancer because of more ambiguous results. Methods Patients with breast cancer diagnosed from 2013 to 2015 and accrued from SEER registries in Georgia and Los Angeles were surveyed (n = 5,080; response rate, 70%), and responses were merged with SEER data and germline genetic testing and results. We examined patient reports of cancer worry by test type and results in 1,063 women who linked to a genetic test and reported undergoing testing. Results More than half of the sample (n = 640; 60.2%) received BRCA1/2-only testing versus 423 patients (39.8%) who had a multigene panel. A minority of tested patients reported substantial cancer worry after treatment: 11.1% (n = 130) reported higher impact of cancer worry, and 15.1% (n = 162) reported a high frequency of cancer worry (worrying often or almost always) in the past month. Impact of cancer worry did not substantively differ by test type, test result outcomes, or clinical or treatment factors. The odds ratio for higher impact of cancer worry was 0.81 (95% CI, 0.51 to 1.28) for multigene versus BRCA1/2-only testing. In a separate model, the odds ratios were 1.21 (95% CI, 0.54 to 2.68) and 0.90 (95% CI, 0.50 to 1.62) for pathogenic variant and variant of uncertain significance, respectively, versus a negative test (the reference group). Conclusion Compared with BRCA1/2 testing alone, multigene panel testing was not associated with increased cancer worry after diagnosis of breast cancer.
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Tewari, Apoorva, and Anees B. Chagpar. "Worry about Breast Cancer Recurrence: A Population-based Analysis." American Surgeon 80, no. 7 (2014): 640–45. http://dx.doi.org/10.1177/000313481408000716.
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As more patients with breast cancer survive treatment, the importance of their long-term quality of life is increasing. One important concern for many survivors is fear of recurrence. To better understand worry about recurrence, we conducted a population-based statistical analysis. The National Health Interview Survey (NHIS) is the largest annual source of health information for the U.S. population. We obtained data from the 2010 survey, which asked breast cancer survivors about their fear of recurrence and quality of life. Data were analyzed using SUDAAN software. The 2010 NHIS sample represented 2,668,697 breast cancer survivors. On univariate analysis, worry about recurrence was correlated with current age ( P = 0.03) and radiation therapy ( P = 0.04). Worry was strongly associated with perceived risk of recurrence ( P < 0.01) and decreased overall quality of life ( P < 0.01) as well as lower self-reported physical ( P < 0.01) and mental ( P < 0.01) health and poor satisfaction with social activities and relationships ( P < 0.01). On multivariate analysis, worry was not independently associated with decreased quality of life ( P = 0.09). However, those who “always worried” about recurrence had a lower quality of life (odds ratio, 0.06; 95% confidence interval, 0.01 to 0.45). Worry about recurrence among breast cancer survivors is associated with age and radiation therapy and is correlated with self-reported physical health, mental health, social relationships, and overall quality of life. It is a significant predictor of decreased quality of life in those who worry the most. Screening for worry about recurrence is an important measure for the improvement of quality of life among breast cancer survivors.
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Artmann, A., M. Heyne, M. Kiechle, and N. Harbeck. "Breast self examination training and counseling as motivation strategies for breast awareness and participation in breast cancer screening programs." Journal of Clinical Oncology 24, no. 18_suppl (2006): 1027. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.1027.
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1027 Background: In Germany, the particpation rate in gynecologic cancer and the Bavarian breast cancer screening program is only about 30%. Therefore, the impact of counseling and raising confidence in breast self examination (BSE) by a structured BSE training on breast awareness, acceptance of screening offer, and participation rate was evaluated. For evaluation of the training quality, specified MammaCare data sheets and questionnaires were used. Method: Since 2003, 167 women (mean age 35 y; range 19–65 y; 61% ≥40 y) got intensive breast cancer counceling and were professionally trained in MammaCare BSE; 41% had positive breast cancer family history. In their beginner’s course, trainees got general BSE information, covering breast anatomy, breast symptoms, breast cancer screening and therapy. Participants practised BSE, after training on tactually accurate silicone breast models with simulated lumps in order to discriminate normal nodularity from lumps. After 3 months, the supervision sessions included BSE evaluation and - again - professional instruction. In a model exam false positive and negative findings were documented. In breast exams, performance technique and breast tissue coverage were assessed. At both initial sessions and after 12 months, questionnaires on BSE practice, experience, and compliance, cancer worry, acceptance and participation at cancer screening programs were evaluated. Results: Breast cancer worry, anxiety, and lack of information were the main reasons for program participation. Within 3 months after the base course, mean decrease of breast cancer worry was about 95%. Participation in gynecologic and breast cancer screening (≥40 y) more than doubled (94% and 86%). Even after 12 months, these numbers remain consistent. 80% of participants practice BSE monthly, and 46% reported changes in lifestyle regarding nutrition and obesity. Conclusions: Our approach emphasizes importance of self confidence and awareness for participation in cancer screening, also in women with breast cancer family history. Counseling, BSE re-evaluation and reinforcement are correlated with decreased breast cancer worry, a main barrier against participation in breast and gynecologic cancer screening. [Table: see text]
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Kreizenbeck, Karma L., Kathryn Egan, Tracy Wong, et al. "Baseline cancer worry and tumor marker testing among earlier-stage breast cancer patients participating in a Choosing Wisely pilot." Journal of Clinical Oncology 38, no. 29_suppl (2020): 153. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.153.
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153 Background: We developed a patient-facing video aimed at raising early breast cancer survivors’ adherence to ASCO’s Choosing Wisely recommendation against surveillance tumor marker testing. To understand the impact of the video on cancer worry regarding recurrence, we surveyed breast cancer survivors before and after viewing the video. Methods: Women with stage I-IIIA breast cancer (N=246) treated at six regional community clinics were surveyed prior to viewing a video at the start of surveillance, then again at follow-up one year later (N=171). Both surveys included the Cancer Worry Scale (CWS-8 items, 4-point Likert scale). Tumor marker (TM) testing during surveillance was collected for 728 patients and linked to surveys among those who provided consent (N=105). Results: Most women (77%) were white age 50+. Among women who completed both questionnaires (N=153), the average CWS summary score was 17.1 at baseline (range=9-29) and 16.9 at follow-up ( p=0.48, range=8-30). Women who did not view the video (A) and those with high baseline cancer worry (B) who viewed the video had similar rates of TM testing (19%) compared to patients with low baseline cancer worry (C) who viewed the video (3%). Cancer worry is highly correlated with the decision to use of TM testing. Viewing an informational video that provided evidence-based advice on follow-up and testing did not impact cancer worry. Enrollment among eligible patients was impacted by challenges to proactively identify and consent patients during their transition to surveillance. Conclusions: Patients with high baseline cancer worry may need different or additional guidance beyond an educational video during their transition to surveillance for breast cancer. [Table: see text]
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Shumway, Dean Alden, Rebecca Leinberger, Kent A. Griffith, et al. "Management of worry about recurrence in breast cancer survivors." Journal of Clinical Oncology 31, no. 31_suppl (2013): 21. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.21.
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21 Background: Worry about recurrence is a significant concern for breast cancer survivors. We explored physicians‘ confidence and practices in identifying and managing worry. Methods: We surveyed a random sample of 1,500 surgeons and medical oncologists drawn from the AMA Masterfile in 2012. Physician responses to questions regarding their confidence were stratified by practice specialty and compared using the Wilcoxon rank-sum test. Correlates of use of each strategy for managing worry were modeled using multiple variable logistic regression. Results: 896 physicians (59.7%) responded: 498 surgeons and 398 medical oncologists, of whom 85.5% saw breast cancer patients. 62% reported initiating discussions regarding worry about recurrence. Overall, medical oncologists reported more confidence than surgeons in their ability to present risk information to patients, identify survivors with high levels of worry, and help patients manage their worry (p<0.001). Of note, 40.2% of physicians reported low levels of confidence managing worries surrounding recurrence. Confidence presenting risk information was significantly associated with treatment volume, which was highest with >50 cases/year. Surgeons who routinely followed breast cancer survivors for >3 years reported higher confidence; no such correlation existed among medical oncologists, but >90% of this group routinely followed patients for >3 yrs. Female physicians were significantly more likely to report being able to identify survivors with high levels of worry. Practice in an academic setting demonstrated associations with increased confidence. Use of worry management strategies varied by specialty. Medical oncologists were more likely to prescribe medication, address concerns in detail themselves, or refer to a psychologist or social worker. Longer follow-up was associated with increased likelihood of physicians addressing concerns themselves. Conclusions: A sizeable minority of physicians lack confidence in their ability to identify and manage worry in cancer survivors. Medical oncologists and surgeons differ significantly in their approach to worry management, suggesting that greater attention toward this issue in training and continuing education may be warranted.
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Lipkus, Isaac M., William M. P. Klein, Celette Sugg Skinner, and Barbara K. Rimer. "Breast cancer risk perceptions and breast cancer worry: what predicts what?" Journal of Risk Research 8, no. 5 (2005): 439–52. http://dx.doi.org/10.1080/1366987042000311018.
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McCaul, KD, AB Canevello, JL Mathwig, and WMP Klein. "Risk communication and worry about breast cancer." Psychology, Health & Medicine 8, no. 4 (2003): 379–89. http://dx.doi.org/10.1080/13548500310001604513.
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Quaife, Samantha L., Jo Waller, Christian von Wagner, and Charlotte Vrinten. "Cancer worries and uptake of breast, cervical, and colorectal cancer screening: A population-based survey in England." Journal of Medical Screening 26, no. 1 (2018): 3–10. http://dx.doi.org/10.1177/0969141318796258.
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Objective Some degree of general worry about cancer may facilitate screening participation, but specific worries about the potential consequences (e.g. treatment, death) may act as deterrents. No studies have examined these associations in the same sample. We assessed associations between general versus specific cancer worries and cancer screening participation. Methods In 2016, a population-based cross-sectional survey of adults living in England was carried out. This paper reports analyses of a subsample (n = 1694). Measures included (i) frequency of general cancer worry, (ii) specific worries about the emotional and physical consequences of a cancer diagnosis, and (iii) specific worries about the social consequences of a cancer diagnosis. Logistic regression analyses examined their association with self-reported screening uptake among participants eligible for cervical (n = 671), breast (n = 323), and colorectal (n = 368) cancer screening. Results Frequency of general cancer worry was not associated with screening participation. Specific worry about the emotional and physical consequences increased the odds of participants reporting regular uptake of colorectal screening (OR 1.41, 95% CI 1.04–1.90). Specific worry about the social consequences of diagnosis was negatively associated with regular attendance for cervical and breast screening in unadjusted analyses only. In adjusted models, the associations were no longer statistically significant for cervical (OR 0.82, 95% CI 0.65–1.03) or breast (OR 0.69, 95% CI 0.45–1.04) screening. Conclusions Specific worries about cancer may be differentially associated with participation across screening programmes. Further research is needed, as interventions to optimise informed participation may be improved if the specific worries associated with low participation in each programme are understood.
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Di Meglio, Antonio, Martina Pagliuca, Stefano Maccarone, et al. "Trajectories of multidimensional worry in survivors of early breast cancer (BC)." Journal of Clinical Oncology 43, no. 16_suppl (2025): 12051. https://doi.org/10.1200/jco.2025.43.16_suppl.12051.
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12051 Background: Worrisome thoughts are common future-oriented behaviors and may affect quality of life (QoL) years removed from BC diagnosis. We aimed to identify trajectories of worry and their determinants, focusing on age-related specificities. Methods: Disease-free stage I-III BC survivors from CANTO (NCT01993498) completed the Impact of Cancer scale v2 at end of treatment (EoT) and years (Y) 1, 3, and 5 post-EoT. Group-based trajectories were identified modeling continuous scores of the worry subscale (range: 1-5, higher = worse), which evaluates uncertainty and worry about the future and health, a sense of time running out, fear of cancer recurrence (FCR), and symptom-triggered FCR. Adjusted multinomial logistic regression incorporating pre-treatment anxiety/depression assessed membership determinants. QoL (EORTC QLQ-C30/BR23) was described by trajectory. Analyses were stratified by age. Results: We included7824 survivors, 31% were ≤50 and 69% > 50 years old. Among those aged ≤50, we identified five worry trajectories: most had high (41%) or very high (18%) worry (mean scores [95% CI] at EoT: 3.57 [3.55-3.60] and 4.37 [4.33-4.41], respectively, stable); 21% showed improvement (2.77 [2.73-2.82] at EoT, 2.14 [2.08-2.21] at Y5); and 12% had low worry (1.58 [1.53-1.63] at EoT, stable). Finally, 7% had moderate worry at EoT (2.21 [2.14-2.28]) that worsened sharply, stabilizing at high levels by Y5 (3.40 [3.29-3.52]). These patterns, especially in the worsening group, were primarily driven by persisting FCR and increasing uncertainty about health. Among those aged > 50, similar trajectories emerged, however worry levels in the worsening group (17%) remained low-to-moderate (2.04 [2.01-2.06] at EoT, 2.34 [2.27-2.40] at Y5). Younger age was a significant determinant of very high worry, both in the ≤50 (Odds Ratio v low worry [95% CI] per 10-year decrease: 1.92 [1.33-2.77]) and in the > 50 age group (1.50 [1.20-1.90]). Partnered status was associated with worsening worry in the ≤50 age group (v not: 2.54 [1.24-5.19]), whereas chemotherapy with very high worry in the > 50 age group (v no chemo: 1.77 [1.14-2.73]). BC grade, stage, BRCA status, family history of cancer, and comorbidities were not linked to worry in either age group. Psychological and physical domains of QoL, including fatigue, sleep, cognitive function, appetite, and gastrointestinal symptoms, were significantly worse in trajectories at higher worry (p < .001 at all time points). Conclusions: More than two-thirds of younger BC survivors report high levels of worry that either remain unchanged or worsen 5 years post-EoT, with a more pronounced decline and different determinants than older counterparts. These patterns appear to be largely driven by the post-traumatic effects of BC on unresolved FCR and by negative projections about health. Early referral to mental health professionals and monitoring strategies focused on reducing anxious arousal are warranted. Clinical trial information: NCT01993498 .
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Gramling, Robert, David Anthony, Georita Frierson, and Deborah Bowen. "The cancer worry chart: a single-item screening measure of worry about developing breast cancer." Psycho-Oncology 16, no. 6 (2007): 593–97. http://dx.doi.org/10.1002/pon.1128.
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van Bommel, Majke H. D., Miranda P. Steenbeek, Joanna IntHout, et al. "Cancer worry among BRCA1/2 pathogenic variant carriers choosing surgery to prevent tubal/ovarian cancer: course over time and associated factors." Supportive Care in Cancer 30, no. 4 (2022): 3409–18. http://dx.doi.org/10.1007/s00520-021-06726-4.
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Abstract Objective High cancer risks, as applicable to BRCA1 and BRCA2 pathogenic variant (PV) carriers, can induce significant cancer concerns. We examined the degree of cancer worry and the course of this worry among BRCA1/2-PV carriers undergoing surgery to prevent ovarian cancer, and identified factors associated with high cancer worry. Methods Cancer worry was evaluated as part of the multicentre, prospective TUBA-study (NCT02321228) in which BRCA1/2-PV carriers choose either novel risk-reducing salpingectomy with delayed oophorectomy or standard risk-reducing salpingo-oophorectomy. The Cancer Worry Scale was obtained before and 3 and 12 months after surgery. Cancer worry patterns were analysed using latent class growth analysis and associated factors were identified with regression analysis. Results Of all 577 BRCA1/2-PV carriers, 320 (57%) had high (≥ 14) cancer worry pre-surgery, and 54% had lower worry 12 months post-surgery than pre-surgery. Based on patterns over time, BRCA1/2-PV carriers could be classified into three groups: persistently low cancer worry (56%), persistently high cancer worry (6%), and fluctuating, mostly declining, cancer worry (37%). Factors associated with persistently high cancer concerns were age below 35 (BRCA1) or 40 (BRCA2), unemployment, previous breast cancer, lower education and a more recent BRCA1/2-PV diagnosis. Conclusions Some degree of cancer worry is considered normal, and most BRCA1/2-PV carriers have declining cancer worry after gynaecological risk-reducing surgery. However, a subset of these BRCA1/2-PV carriers has persisting major cancer concerns up to 1 year after surgery. They should be identified and potentially offered additional support. Clinical trial registration The TUBA-study is registered at ClinicalTrials.gov since December 11th, 2014. Registration number: NCT02321228.
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McCaul, Kevin D., Dawn M. Schroeder, and Patricia A. Reid. "Breast cancer worry and screening: Some prospective data." Health Psychology 15, no. 6 (1996): 430–33. http://dx.doi.org/10.1037/0278-6133.15.6.430.
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Mathews, A., V. Ridgeway, R. Warren, and P. Britton. "Predicting worry following a diagnosis of breast cancer." Psycho-Oncology 11, no. 5 (2002): 415–18. http://dx.doi.org/10.1002/pon.600.
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Caruso, Anita, Cristina Vigna, and Paola Gremigni. "The Cancer Worry Scale Revised for Breast Cancer Genetic Counseling." Cancer Nursing 41, no. 4 (2018): 311–19. http://dx.doi.org/10.1097/ncc.0000000000000511.
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Xie, Xiuyuan, Haiping Xu, Yujie Fei, and Fenghe Liu. "Effects of nursing intervention based on gratitude extension-construction theory on gratitude level, recurrence fear and post-traumatic growth of patients with breast cancer after surgery." Journal of Clinical Oncology 42, no. 16_suppl (2024): e23162-e23162. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.e23162.
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e23162 Background: To explore the effects of nursing intervention based on gratitude extension-construction theory on gratitude level, recurrence fear and post-traumatic growth of patients after breast cancer surgery. Methods: 104 patients with breast cancer treated in a large general hospital from August 2023 to January 2024 were selected as the study objects, and randomly divided into control group and intervention group with 52 cases in each group. The control group received routine nursing intervention, and the intervention group was treated with nursing intervention based on gratitude extension and construction theory on the basis of routine nursing intervention. The intervention plan included organizing patients to give motivational lectures before discharge, watching gratitude videos, and teaching patients to carry out positive memory, gratitude meditation and gratitude expression every day through bedside talk. After discharge, patients were instructed to conduct interest cultivation, gratitude expression, gratitude visit, gratitude diary and gratitude sharing through phone or wechat follow-up. After 12 weeks, the results were evaluated by general information questionnaire, gratitude level questionnaire, Cancer Recurrence Fear Scale, and post-traumatic Growth Rating Scale. Results: After intervention, the gratitude level of the intervention group was significantly higher than that of the control group (P < 0.001), the total score and all dimension scores of fear of cancer recurrence were significantly lower than those of control group (P < 0.05), post-traumatic growth score and all dimensions were higher than those of control group (P < 0.001). Conclusions: This study established a set of scientific, practical and effective intervention program suitable for patients with breast cancer after surgery to improve the level of gratitude, alleviate the fear of cancer recurrence, and promote post-traumatic growth, and verified that the intervention program can effectively improve the level of gratitude of patients, especially in the aspect of gratitude around people and matters. It can also alleviate the fear of cancer recurrence, overall worry, health worry, female worry, role worry, death worry, etc. Post-traumatic growth has been significantly improved, especially in terms of personal strength and interpersonal relationship improvement. Under the general trend that breast cancer has become the largest cancer in the world, it is one of the effective ways to improve the psychological state of breast cancer patients, and it is worth promoting in breast cancer patients.
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Parker, Patricia A., Susan K. Peterson, Yu Shen, et al. "Prospective Study of Psychosocial Outcomes of Having Contralateral Prophylactic Mastectomy Among Women With Nonhereditary Breast Cancer." Journal of Clinical Oncology 36, no. 25 (2018): 2630–38. http://dx.doi.org/10.1200/jco.2018.78.6442.
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Purpose The incidence of contralateral prophylactic mastectomy (CPM) has continued to increase. We prospectively examined psychosocial outcomes before and up to 18 months after surgery in women who did or did not have CPM. Methods Women with unilateral, nonhereditary breast cancer completed questionnaires before and 1, 6, 12, and 18 months after surgery. Primary psychosocial measures were cancer worry and cancer-specific distress. Secondary measures were body image, quality of life (QOL), decisional satisfaction, and decisional regret. Results A total of 288 women (mean age, 56 years; 58% non-Hispanic white) provided questionnaire data, of whom 50 underwent CPM. Before surgery, women who subsequently received CPM had higher cancer distress ( P = .04), cancer worry ( P < .001), and body image concerns ( P < .001) than women who did not have CPM. In a multivariable repeated measures model adjusted for time, age, race/ethnicity, and stage, CPM was associated with more body image distress ( P < .001) and poorer QOL ( P = .02). There was a significant interaction between time point and CPM group for cancer worry ( Pinteraction < .001), suggesting that CPM patients had higher presurgery cancer worry, but their postsurgery worry decreased over time and was similar to the worry of patients who did not have CPM. QOL was similar between CPM groups before surgery but declined 1 month after surgery and remained lower than patients who did not have CPM after surgery ( Pinteraction = .05). Conclusion These results may facilitate informed discussions between women and their physicians regarding CPM. Fear and worry may be foremost concerns at the time surgical decisions are made, when women may not anticipate the adverse future effect of CPM on body image and QOL.
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Argov, Erica J. Lee, Carmen B. Rodriguez, Mariangela Agovino, et al. "Abstract B011: Breast cancer worry, uncertainty, and perceived risk following breast density notification in a longitudinal mammography screening cohort vary by educational attainment and dominant language." Cancer Epidemiology, Biomarkers & Prevention 32, no. 1_Supplement (2023): B011. http://dx.doi.org/10.1158/1538-7755.disp22-b011.
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Abstract Introduction: Socioeconomic, racial and ethnic disparities in the awareness and knowledge of dense breast notification (DBN) legislation have been documented, but its effect on women’s cognitive and emotional appraisal of the notification information which affect screening behavior remains unknown. Ambiguous screening and follow-up care for women with dense breasts may allow DBN to increase women’s anxiety, perceptions of risk, and worry, with unclear consequences for future screening decisions. We examined short- and long-term psychological responses to DBN and awareness of breast density (BD) by education, health literacy, nativity and dominant language. Methods: In a predominantly Latina and foreign-born New York City screening cohort (63% Spanish-speaking), ages 40-60, we assessed breast cancer worry, perceived absolute and comparative breast cancer risk, and uncertainties about breast cancer risk and screening choices, in short (approximately 1-3 months) and long-term (approximately 9-18 months) surveys following the enrollment screening mammogram (between 2016-2018). We compared psychological responses by women’s dense breast status (as proxy for DBN receipt) and BD awareness using cumulative, binary, and multinomial logistic regression. We examined multiplicative interaction by education, health literacy, nativity, and interview language. Results: In multivariable models using short-term surveys, BD awareness was associated with increased absolute perceived risk (Odds Ratio (OR): 2.27, 95% Confidence Interval (CI): 0.99, 5.20 for high, OR: 2.19, 95% CI: 1.34, 3.58 for moderate, vs. low risk) in the overall sample, and with increased uncertainty about risk (OR: 1.97 per 1-unit increase, 95% CI: 1.15, 3.39) and uncertainty about screening choices (OR: 1.73 per 1-unit increase, 95% CI: 1.01, 2.9) in women who are Spanish-dominant. DBN was associated with decreased perceived risk among women with at least some college education (OR: 0.32, 95% CI: 0.11, 0.89, for high, OR: 0.50, 95% CI 0.29, 0.89, for moderate vs. low risk) while those with a high school education or less experienced an increase (OR: 3.01, 95% CI: 1.05, 8.67 high vs. low risk). There were no associations observed between DBN or BD awareness and short-term breast cancer worry, nor with any psychological outcomes at long-term surveys. Conclusions: Associations of BD awareness and notification with breast cancer related psychological outcomes differed by education and language and were limited to short term increases in perceived absolute breast cancer risk and uncertainty around breast cancer risk and screening choices. Women with lower educational attainment or language barriers could specifically benefit from outreach to clarify the implications of breast density and reduce uncertainty around risk and screening choices. Citation Format: Erica J. Lee Argov, Carmen B. Rodriguez, Mariangela Agovino, Ying Wei, Rachel C. Shelton, Rita Kukafka, Karen M. Schmitt, Elise Desperito, Mary Beth Terry, Parisa Tehranifar. Breast cancer worry, uncertainty, and perceived risk following breast density notification in a longitudinal mammography screening cohort vary by educational attainment and dominant language [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B011.
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Swathi, Hogarehalli Jayanna, Hogarehalli Jayanna Vinayaka, Varsha R. Mokhasi, and Byrappa Nirmala Bhanuprasad. "Factors affecting the participation and utilization of breast cancer screening services among health care workers Kolar: a qualitative study." International Journal Of Community Medicine And Public Health 11, no. 5 (2024): 1931–35. http://dx.doi.org/10.18203/2394-6040.ijcmph20241190.
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Background: India is going through epidemiologic transition with a shift of disease burden from communicable to non-communicable diseases. There is no organized screening programme for breast cancer in the country. Hence, a large proportion of women with cancer of the breast present in advanced stages of cancer. The integrated cancer control programme calls for early detection of cancer, opportunistic screening and cancer outreach camps that are to be promoted and carried out by health care providers. The objective of this study was thus designed to understand the various factors preventing the participation and utilisation of breast cancer screening. Methods: It was a qualitative method with two groups. The study was conducted between two taluks out of 6, Kolar and Bangarpete. All Angawadi workers and helpers aged more than 30 years were invited and those who have history of breast cancer and family history of breast cancer were excluded from the study. All the subjects who did not attend the screening were included to elicit the reasons for non-attendance. Results: The theme ‘barriers to screening uptake’ were broadly divided into three main categories- namely ‘worry’, ‘transport’ and ‘work commitment’. The sub-category ‘anxiety’ (31.9%) was reported to be the highest barrier and least was in the sub-category ‘no replacement’ (4.3%). The frequency of response categorized into different sub-categories. Conclusions: The reasons were identified by using ‘single question’ interview guide, and were categorized into ‘worry’, ‘transport’ and ‘work-commitment’. Barrier in ‘worry’ category was found to be highest.
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Bowen, Deborah J., and Diane Powers. "Effects of a Mail and Telephone Intervention on Breast Health Behaviors." Health Education & Behavior 37, no. 4 (2010): 479–89. http://dx.doi.org/10.1177/1090198109348463.
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This study evaluated a mail and telephone intervention to improve breast health behaviors while maintaining quality of life. Women recruited from the general public were randomized to a stepped-intensity intervention consisting of mailings, telephone calls, and counseling (if requested or appropriate given a woman’s genetic risk for breast cancer) or to a delayed treatment control group. Outcomes (mammography screening and quality of life) were measured at baseline in a telephone survey and again at a 12-month follow-up period. Women in the intervention group significantly increased screening mammography uptake by 12% and quality of life by 5.3 scale points compared to control participants. Changes in knowledge of breast cancer, genetic testing, and cancer worry all significantly predicted intervention changes. This successful intervention can help women make better breast health choices without causing increased worry.
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Loescher, Lois J. "Cancer Worry in Women With Hereditary Risk Factors for Breast Cancer." Oncology Nursing Forum 30, no. 5 (2003): 767–72. http://dx.doi.org/10.1188/03.onf.767-772.
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Janz, N. K., S. T. Hawley, M. S. Mujahid, J. Graff, A. S. Hamilton, and S. J. Katz. "Correlates and mediators of worry about breast cancer recurrence." Journal of Clinical Oncology 28, no. 15_suppl (2010): 9098. http://dx.doi.org/10.1200/jco.2010.28.15_suppl.9098.
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Naeem, Shafia, Faisal Mahmood, Ali Qamar, et al. "SCREENING MAMMOGRAPHY." Professional Medical Journal 21, no. 01 (2014): 039–43. http://dx.doi.org/10.29309/tpmj/2014.21.01.1926.
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Background: Worry about risk for breast cancer and pain are associated withmammography use. Both have been found to be a barrier to mammography use by women.Objective: To examine the anxiety and pain associated with mammography use in a sample ofwomen stratified according to breast cancer risk. Design: This prospective observational study.Setting: Department of Obstetric and Gynecology, Benazir Bhutto Hospital. Period: August2011 to June 2012. Patients & Methods: Women awaiting screening mammography in thereception area were asked to complete a questionnaire containing demographics for calculationof breast cancer risk and the Likert scale for anxiety before the procedure and VAS forassessment of pain after the procedure. Results: Our study included 100 women undergoingscreening mammography with an average age of 53.9±8.8 years. 15% were classified “higherrisk” by the Gail model. The average anxiety level was 4.03±1.3 on Likert scale and average painduring the procedure was 3.3±2.18 on VAS. Significant differences (p<0.05) were foundbetween average and higher risk groups. Conclusions: The population of women in this sampleappears to have a level of breast cancer worry and procedure related pain that is proportionalwith their risk for developing breast cancer.
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Pahlevan Sharif, Saeed, Ashraf Sadat Ahadzadeh, Fon Sim Ong, and Navaz Naghavi. "Fear of negative appearance evaluation and attitude towards mammography: Moderating role of internal health locus of control,cancer worry and age." Health Promotion Perspectives 10, no. 3 (2020): 220–29. http://dx.doi.org/10.34172/hpp.2020.35.
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Background: Mammography screening tends to reduce mortality rate through early detection. One of the barriers to mammography screening is fear of negative appearance evaluation(FNAE). This study investigated the impact of internal health locus of control, breast cancer worries and age on the relationship between FNAE and attitude towards mammography. Methods: A cross-sectional, questionnaire-based survey design was used. Samples were Iranian women, living in Iran, aged at least 30 years old, without any history of cancer, and had not performed mammography previously based on self-report. In total, 823 samples were collected through conducting an online survey from April to June 2016. The questionnaire consisted of several instruments including attitude toward breast cancer screening procedures scale, FNAEscale, the internal dimension of the multidimensional health locus of control, and two items to measure breast cancer worry. Using covariance-based structural equation modeling the model was tested. Results: The interaction of FNAE with internal health locus of control (β = -0.128, P<0.05,CI: -0.200, -0.056), breast cancer worry (β = 0.090, P<0.05, CI: -0.162, -0.017), and age (β =-0.095, P<0.05, CI = -0.163, -0.026) was significant. The three tested moderators dampened the positive relationship between FNAE and negative attitude towards mammography. Conclusion: More information about the screening procedure should be given to women to overcome their fear. The findings indicate the need for interventions seeking to shift women’s health locus of control from external to internal. Women with low level of cancer worry need more attention.
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Parger, Anna-Maria, Daniela Muhr, Christian F. Singer, and Yen Y. Tan. "Abstract P4-12-10: Cancer worry among healthy BRCA mutation carriers in Austria: A pilot study." Cancer Research 82, no. 4_Supplement (2022): P4–12–10—P4–12–10. http://dx.doi.org/10.1158/1538-7445.sabcs21-p4-12-10.
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Abstract Background: Breast cancer risk in BRCA mutation carriers is up to 10 times higher compared to the general population. To support these patients, it is imperative to understand the worry that these patients face when they find out that they are a pathogenic mutation carrier. The aim of this study was to assess cancer worry among healthy BRCA mutation carriers using the 8-item cancer worry instrument. As there is no German version available, the aim of the study was two-fold. One was to translate the cancer worry scale (CWS) into German, and the second was to pilot the questionnaire to compare cancer worry between BRCA mutation carriers and gender. Methods: Healthy patients who underwent genetic counselling/testing at the Medical University of Vienna/Vienna General Hospital were randomly identified from 2015-2020. The English version of the 8-item CWS was forward and backwards translated by independent interpreters. A final version was composed together with medical doctors, a breast care nurse and a psychologist. The final version was piloted to a small group of healthy BRCA mutation carriers. A total of 63 potential participants [BRCA1: N=41 (65%), BRCA2: N=22 (35%); female: N=50 (79%), male: N=13 (21%)] were identified and invited to participate in the study. An invitation pack including an invitation letter, a patient consent form and the translated instrument was sent out in January 2021. Non-responders were followed up twice by phone calls. With the feedback, a final version was put together with another independent translator and confirmed by the committee. Results: Of 63 potential participants, 35 (female: 30, 85% vs. male: 5, 14%) returned the questionnaire after 2 follow-up calls, giving a response rate of 56%. Twenty-eight individuals (80%) carry a BRCA1 mutation, while remaining 7 (20%) were BRCA2 mutation carriers. All participants were native German speakers. Their age when completing the questionnaire differ significantly between BRCA1 (median age: 40 years; range: 26-68 years) and BRCA2 (median age: 51 years; range: 30-64 years) carriers (p=0.028). Almost half of all participants work full time (46%) and have an average or high income (69% = more than 18.000 Euros/year net income). It is noteworthy, that 57% underwent prophylactic surgery, such as mastectomy, adnexectomy, salpingectomy or both, mastectomy and adnexectomy. Of 35 respondents who completed the CWS, 27 (77%) reported high cancer worry. All male responders reported high cancer worry versus 22 females. Although no significant difference. was observed between gender, it is remarkable that men worry more about the possibility of family members developing cancer than their female counterparts (60% male vs 24% female). However, no one indicated that their worry interferes with their ability to conduct daily activities. Interestingly, those with average or high income report higher cancer worry than their counterparts (p= 0.024), and those who underwent risk-reducing surgery, regardless of type of surgery, were found to have significantly less cancer worry compared to those who did not undergo risk-reducing surgery (p=0.014). There were no differences observed in cancer worry between BRCA mutation group (81% BRCA1 vs 71% BRCA2, p=0.615), employment status (p=0.064), marital status (p=0.306), education (p=0.875), or being more physically active (p=0.715). Conclusion: Our results show that although men were less motivated to participate, they worry more than their female counterparts. In addition, those who with higher income also experience higher cancer worry. To our knowledge, this is the first time CWS has been translated to German and for use in the high-risk BRCA population. Our results are hampered by small sample size and remain to be validated in a larger study. Citation Format: Anna-Maria Parger, Daniela Muhr, Christian F Singer, Yen Y Tan. Cancer worry among healthy BRCA mutation carriers in Austria: A pilot study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-10.
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Namlı, Sümeyra Betül, Sibel Tunç Karaman, and Okcan Basat. "Investigation of the Effect of Women’s Breast Cancer Worry Levels on Breast Cancer Prevention Behavior." European Journal of Breast Health 19, no. 4 (2023): 279–86. http://dx.doi.org/10.4274/ejbh.galenos.2023.2023-4-4.
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Zhang, Casey, Alberto Vera, Kelly Murphy, et al. "Tumor-to-Breast Volume Ratio and Outcomes After Oncoplastic Breast Conserving Surgery." Annals of Plastic Surgery 94, no. 4S (2025): S297—S304. https://doi.org/10.1097/sap.0000000000004288.
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Introduction Oncoplastic breast conserving surgery (OBCS) can offer oncologically safe and cosmetically satisfying results for patients with breast cancer. However, the relative oncologic safety of high tumor-volume oncoplastic resections is largely unknown. This study investigated the association between tumor-to-breast volume ratio, recurrence, and surgical complications in OBCS. The relationship between tumor-to-breast ratio and quality of life was also assessed. Methods A retrospective review was performed for all women who underwent OBCS for breast cancer between 2010 and 2023 at a university-based tertiary referral center. The BREAST-Q questionnaire was utilized to assess quality of life outcomes. Tumor-to-breast ratio was calculated by dividing lumpectomy specimen volume by total breast volume. Surgical complications, reexcision, local recurrence, and revision procedures were noted. Multivariate logistic regression was performed to assess the association of tumor-to-breast ratio with outcomes. Results This study included 192 patients, of which 65 (34%) completed the BREAST-Q. Median tumor-to-breast volume ratio was 7.3% (IQR, 3.6%–12.5%). Quartiles of tumor-to-breast ratio were not associated with local cancer recurrence rate (P = 0.50), reexcision (P = 0.29), wound-related complications (P = 0.45), complications requiring reoperation (P = 0.34), and elective revision of reconstruction (P = 0.67). BREAST-Q scores for Psychosocial Well-being, Physical Well-being, and Overall Satisfaction were similar across tumor-to-breast ratio. Cancer worry was significantly higher in larger tumor-breast ratio quartiles (P = 0.03). Conclusions These data suggest that OBCS is a reasonable approach for patients with higher tumor-to-breast ratio. Complications and quality of life metrics did not appear to vary significantly with increasing tumor size, except for “cancer worry,” which was higher among patients with larger tumor-breast ratio patients.
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Ghosh, Karthik, Sarah Jenkins, Jennifer Ridgeway, et al. "Abstract P6-05-38: Breast Density Notification: Impact on anxiety, breast cancer worry, and self-perceived risk among Latinas at a federally qualified medical center." Cancer Research 83, no. 5_Supplement (2023): P6–05–38—P6–05–38. http://dx.doi.org/10.1158/1538-7445.sabcs22-p6-05-38.
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Abstract Mammographic breast density (MBD) has been shown to be a strong, independent risk factor for breast cancer (BC) irrespective of race/ethnicity. Given the risk association of MBD and its potential to mask tumors on a mammogram, state and federal laws have mandated that women receive information regarding their personal MBD in their mammography reports. However, concerns have been raised regarding the impact of MBD notification on patient anxiety, especially written information for women who experience health disparities such as racial/ethnic minorities, lower health literacy, limited English proficiency and lower socioeconomic status. We performed a randomized controlled clinical trial to examine the impact of three different written and interpersonal approaches to MBD notification on patient anxiety, BC worry, and self-perceived BC risk, among Latinas receiving routine mammography screening at a federally qualified medical center (FQHC). We hypothesized that interpersonal education would reduce anxiety and worry, relative to the written notifications alone. The study was performed at the Baseline Clinic of Mountain Park Health Center, a FQHC in Phoenix, AZ. Women between ages 40 and 74 years presenting for screening mammogram were eligible. After providing signed informed consent, participants were randomized equally to usual care (UC- mailed notification letter); enhanced care (notification letter and MBD educational brochure designed for this study): interpersonal care (notification letter, brochure, promotora education via telephone). A stratified block randomization procedure was used with age &gt; 50 years (yes vs no), ethnicity (Hispanic vs non-Hispanic), and language preference (Spanish vs. English) as strata. Study participants completed surveys at the time of enrollment/pre-intervention (T0), at two weeks to six months after intervention was delivered (T1), and about one year after randomization (T2). Anxiety state was measured using the state anxiety subscale of the State-Trait Anxiety Inventory scale (STAI-S) (range from 20-80). BC worry was probed using the question: “How frequently do you worry about getting breast cancer someday”. The self-perceived lifetime risk of BC was rated between 0% (no chance of BC) to 100% (definitely will get BC). The proportion of participants with an increase or persistence of higher level for each outcome between time points was compared between the three study groups. The study was approved by the Mayo Clinic Institutional Review Board. 1332 Latina women were enrolled and randomized between October 2016 and October 2019. All completed the baseline (T0) survey, 928 completed T1, 632 completed T2, and 516 completed both T1 and T2 surveys. At study entry, majority of the participants were young (64.1% between age 40-49 years), had no family history of breast cancer (81.0%), had less than high school education (68.8%), and were married or partnered (67.8%). At T0, the mean (SD) anxiety STAI score was 32.5 (11.1); 51.8% with moderate or severe anxiety (score &gt; 30). With regard to BC worry, 41.3% reported worrying “sometimes”, “often”, or “almost all the time”. Further, 25.4% reported a self-perceived lifetime risk of developing BC of &gt;10% while only 6.6% had a Gail model estimated lifetime risk score of &gt;10%. There was no significant difference in changes in anxiety, BC worry or self-perceived risk from T0 to either T1 or T2 surveys between the intervention groups. In summary, this study found high levels of baseline anxiety and BC worry (despite the majority being 40-49 years old and having no family history of BC) which persisted regardless of how notification and education were delivered. Future work is needed to improve the understanding of factors that could lower anxiety and BC worry and improve risk perception in this population. Citation Format: Karthik Ghosh, Sarah Jenkins, Jennifer Ridgeway, Jessica D. Austin, Bijan Borah, Bhavika K. Patel, Deborah Rhodes, Aaron Norman, Edna P. Ramos, Matt Jewett, Crystal Gonzalez, Valentina Hernandez, Davinder Singh, Vera Suman, Celine Vachon. Breast Density Notification: Impact on anxiety, breast cancer worry, and self-perceived risk among Latinas at a federally qualified medical center. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-38.
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Imani, Momene, Shamsi Khalili, Moslem Zohrei, and Masome Fasihi. "The Mediating Role of Metacognitive Beliefs and Worry in the Relationship Between Intolerance of Uncertainty and Health Anxiety in Female Breast Cancer Survivors." Journal of Cognition, Behavior, Learning 1, no. 4 (2024): 201–12. https://doi.org/10.61838/jcbl.1.4.15.
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The present study aimed to investigate the mediating role of metacognitive beliefs and worry in the relationship between intolerance of uncertainty and health anxiety in female breast cancer survivors. This study employed a descriptive correlational design. The statistical population consisted of all women who had recovered from breast cancer in the city of Sirjan in 2024. From this population, 216 women were selected through convenience sampling. The research instruments included the Health Anxiety Questionnaire developed by Salkovskis et al. (2002), the Penn State Worry Questionnaire by Meyer et al. (1990), the Metacognition Questionnaire-30 (MCQ-30) by Wells and Cartwright-Hatton (2004), and the Intolerance of Uncertainty Scale–Version 2 (IUS-2) by McLean (2009). Data were analyzed using structural equation modeling (SEM). The results indicated that worry significantly and positively mediated the relationship between intolerance of uncertainty and health anxiety (β = 0.081, p = 0.028). Metacognitive beliefs also significantly and positively mediated the relationship between intolerance of uncertainty and health anxiety (β = 0.072, p = 0.039). It appears that as the level of uncertainty tolerance increases in these women, they experience lower levels of metacognitive beliefs and worry, and consequently, reduced health anxiety.
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Berman, Marc G., Mary K. Askren, Misook Jung, et al. "Pretreatment worry and neurocognitive responses in women with breast cancer." Health Psychology 33, no. 3 (2014): 222–31. http://dx.doi.org/10.1037/a0033425.
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Joseph, Galen, and Claudia Guerra. "To worry or not to worry: breast cancer genetic counseling communication with low-income Latina immigrants." Journal of Community Genetics 6, no. 1 (2014): 63–76. http://dx.doi.org/10.1007/s12687-014-0202-4.
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Hindmarch, Sarah, Sacha J. Howell, Juliet A. Usher-Smith, Louise Gorman, D. Gareth Evans, and David P. French. "Feasibility and acceptability of offering breast cancer risk assessment to general population women aged 30–39 years: a mixed-methods study protocol." BMJ Open 14, no. 1 (2024): e078555. http://dx.doi.org/10.1136/bmjopen-2023-078555.
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IntroductionBreast cancer incidence starts to increase exponentially when women reach 30–39 years, hence before they are eligible for breast cancer screening. The introduction of breast cancer risk assessment for this age group could lead to those at higher risk receiving benefits of earlier screening and preventive strategies. Currently, risk assessment is limited to women with a family history of breast cancer only. The Breast CANcer Risk Assessment in Younger women (BCAN-RAY) study is evaluating a comprehensive breast cancer risk assessment strategy for women aged 30–39 years incorporating a questionnaire of breast cancer risk factors, low-dose mammography to assess breast density and polygenic risk. This study will assess the feasibility and acceptability of the BCAN-RAY risk assessment strategy.Methods and analysisThis study involves women undergoing risk assessment as part of the BCAN-RAY case-control study (n=750). They will be aged 30–39 years without a strong family history of breast cancer and invited to participate via general practice. A comparison of uptake rates by socioeconomic status and ethnicity between women who participated in the BCAN-RAY study and women who declined participation will be conducted. All participants will be asked to complete self-report questionnaires to assess key potential harms including increased state anxiety (State Trait Anxiety Inventory), cancer worry (Lerman Cancer Worry Scale) and satisfaction with the decision to participate (Decision Regret Scale), alongside potential benefits such as feeling more informed about breast cancer risk. A subsample of approximately 24 women (12 at average risk and 12 at increased risk) will additionally participate in semistructured interviews to understand the acceptability of the risk assessment strategy and identify any changes needed to it to increase uptake.Ethics and disseminationEthical approval was granted by North West—Greater Manchester West Research Ethics Committee (reference: 22/NW/0268). Study results will be disseminated through peer-reviewed journals, conference presentations and charitable organisations.Trial registration numberNCT05305963.
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Quillin, John M., Joann N. Bodurtha, Donna McClish, and Diane Baer Wilson. "Genetic Risk, Perceived Risk, and Cancer Worry in Daughters of Breast Cancer Patients." Journal of Genetic Counseling 20, no. 2 (2010): 157–64. http://dx.doi.org/10.1007/s10897-010-9336-7.
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Diefenbach, Michael A., Suzanne M. Miller, and Mary B. Daly. "Specific worry about breast cancer predicts mammography use in women at risk for breast and ovarian cancer." Health Psychology 18, no. 5 (1999): 532–36. http://dx.doi.org/10.1037/0278-6133.18.5.532.
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Pandya, Tanvi, Zixuan Liu, Hankiz Dolan, et al. "Australian Women’s Responses to Breast Density Information: A Content Analysis." International Journal of Environmental Research and Public Health 20, no. 2 (2023): 1596. http://dx.doi.org/10.3390/ijerph20021596.
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Breast density (BD) is an independent risk factor for breast cancer and reduces mammographic sensitivity. This study explored women’s responses and intentions if notified that they had dense breasts. Methods: Content analysis was used to assess responses from a written questionnaire undertaken in conjunction with focus groups on BD involving 78 Australian women aged 40–74. Results: Half the women reported that they would feel a little anxious if notified they had dense breasts, while 29.5% would not feel anxious. The most common theme (29.5%) related to anxiety was the psychosocial impact of the possibility of developing cancer, and women believed that being better informed could help with anxiety (26.9%). When asked what they would do if notified of having dense breasts, the most common response was to consult their doctor for information/advice (38.5%), followed by considering supplemental screening (23%). Consequently, when asked directly, 65.4% were interested in undergoing supplemental screening, while others (10.3%) said they “wouldn’t worry about it too much”. Discussion: These findings have important implications for health systems with population-based breast screening programs that are currently considering widespread BD notification in terms of the impact on women, health services and primary care.
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Rondanina, Gabriella, Matteo Puntoni, Gianluca Severi, et al. "Psychological and Clinical Factors Implicated in Decision Making About a Trial of Low-Dose Tamoxifen in Hormone Replacement Therapy Users." Journal of Clinical Oncology 26, no. 9 (2008): 1537–43. http://dx.doi.org/10.1200/jco.2007.13.6739.
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Purpose To assess the sociodemographic, health-related, and psychological factors that influence the decision of women on hormone replacement therapy (HRT) to participate in a phase III trial of low-dose tamoxifen. Patients and Methods Clinical and psychological factors were assessed in 265 women who accepted and 192 women who refused to participate in a proposed trial. Health-related and sociodemographic factors included age, Gail risk, body mass index, education, current HRT use, regular mammographic screening, smoking habit, physical activity, alcohol use, concern about adverse effects, and physician recommendation. Psychological factors included breast cancer–related worry, absolute and comparative cancer risk perception, anxiety, and depression. Results The most frequent reasons for entry were willingness to participate in a research program (60%), the need/desire to receive frequent medical care (58%), and the desire to contribute to medical knowledge (44%); whereas reasons for refusal included fear of medication abuse (33%), concern about adverse effects (31%), and physician advice against enrollment (24%). In a logistic model, after adjusting for current HRT use, the trial participation was directly associated with satisfaction with clearly explained study objectives (odds ratio [OR] = 9.33; 95% CI, 4.04 to 21.55) and inversely associated with high breast cancer worry (OR = 0.15; 95% CI, 0.03 to 0.77) and age ≥ 60 years (OR = 0.40; 95% CI, 0.22 to 0.73). Conclusion Participation in a chemoprevention trial among HRT users is associated with a younger age, no breast cancer worry, and satisfaction with health care providers, suggesting a condition of psychological well-being as a promoting factor and emphasizing the importance of thorough counseling at study presentation.
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Brand, Hannah, Dorothee Speiser, Laura Besch, Julia Roseman, and Friederike Kendel. "Making Sense of a Health Threat: Illness Representations, Coping, and Psychological Distress among BRCA1/2 Mutation Carriers." Genes 12, no. 5 (2021): 741. http://dx.doi.org/10.3390/genes12050741.
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Little is known about how women with a BRCA1/2 mutation develop an individual understanding of their breast and ovarian cancer risk and how this affects their psychological distress. In this study, we investigated associations between illness representations, coping strategies and psychological distress. N = 101 BRCA1/2 mutation carriers answered self-report questionnaires on illness representations, coping strategies, cancer worry and depressive symptoms. Women without cancer were compared to women with a previous cancer diagnosis. Illness representations explained 50% and 45% of the variability in cancer worry and depressive symptoms, respectively. Woman perceiving severe consequences (β = 0.29, p < 0.01) and having more concerns (β = 0.37, p < 0.01) were found to report more cancer worry. Perceiving information about the mutation as less coherent (β = −0.17, p < 0.05) and experiencing negative emotional responses (β = 0.60, p < 0.01) were both associated with more depressive symptoms. Women with a previous cancer diagnosis show patterns of illness representations that are potentially more distressing than women without a cancer diagnosis. Findings suggest that physicians involved in counseling should pay attention to illness representations of distressed women. Thereby, it would be possible to detect maladaptive thoughts associated with the mutation, address negative emotions and encourage adaptive coping strategies.
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Ghanouni, Alex, Christian von Wagner, and Jo Waller. "Public awareness of and responses to media coverage of invitation errors in the Breast Screening Programme in England: a cross-sectional population survey." BMJ Open 9, no. 9 (2019): e028040. http://dx.doi.org/10.1136/bmjopen-2018-028040.
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ObjectivesIn May 2018, the British Health Secretary announced the ‘serious failure’ that 450 000 women had missed out on invitations to breast screening in England, leading to extensive media coverage. This study measured public awareness of the story and tested for associated factors (eg, educational level and trust in the National Health Service (NHS)).DesignA computer-assisted face-to-face survey in June 2018.SettingParticipants completed the survey in their homes.ParticipantsMales and females aged 16 years or older in England.Primary and secondary outcome measuresAwareness of aspects of the media coverage and reported statistics. Other data included demographics (eg, ethnicity), awareness of unrelated contemporaneous news stories, trust in participants’ general practitioners (GPs) and the NHS, and (among women) worry about breast cancer and future breast screening intentions.ResultsDescriptive statistics showed that 67% of 1894 participants reported being aware of the media coverage. Regression analyses showed that those who were aware of other news stories, were white British and had a higher level of education or social grade were more likely to be aware. In contrast, only 36% correctly identified at least one of two headline statistics. This study did not find evidence that awareness was negatively associated with trust in participants’ GPs or the NHS, breast cancer worry or future breast cancer screening intentions.ConclusionsAwareness of the breast screening news story was high but recall of reported statistics was much lower: the public may have retained only the gist of quantitative information. Associations between story awareness and attitudes or behaviour were not apparent.
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Retnaningsih, Dwi, Roudhotul Auliyak, Mariyati Mariyati, and Enggar Nurnaningsih. "Depression and Fatigue of Breast Cancer Patients Receiving Chemotherapy during the Covid-19." Indonesian Journal of Global Health Research 3, no. 3 (2021): 297–304. http://dx.doi.org/10.37287/ijghr.v3i3.510.
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Depression in breast cancer patients includes mental shock, inability to accept reality, hopelessness, fear of death, and fear of the future. Depression creates long periods of sadness and worry, usually accompanied by feelings of worthlessness. Fatigue is a symptom that often appears in cancer patients undergoing chemotherapy. Associated with the conditions of the COVID-19 pandemic, cancer patients have an increased risk of transmitting COVID-19 because they have decreased endurance. This study aims to determine the relationship between depression and fatigue in breast cancer patients undergoing chemotherapy at Hospital Sultan Agung Semarang Indonesia. The instruments used in this study were questionnaire of the hospitals anxiety and Depression Scale (HADS) and questionnaire of fatigue, 30 female respondents who suffer from breast cancer and have undergone chemotherapy. Rank Spearman data analysis. P value = 0.000 and correlation coefficient value r = 0.671. There is a relationship between depression and fatigue in breast cancer patients undergoing chemotherapy which has an impact on adherence to chemotherapy for breast cancer patients. The higher the level of depression is, the more severe the level of fatigue in cancer patients.
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Forrest, Laura E., Rowan Forbes Shepherd, Erin Tutty, et al. "The Clinical and Psychosocial Outcomes for Women Who Received Unexpected Clinically Actionable Germline Information Identified through Research: An Exploratory Sequential Mixed-Methods Comparative Study." Journal of Personalized Medicine 12, no. 7 (2022): 1112. http://dx.doi.org/10.3390/jpm12071112.
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Background Research identifying and returning clinically actionable germline variants offer a new avenue of access to genetic information. The psychosocial and clinical outcomes for women who have received this ‘genome-first care’ delivering hereditary breast and ovarian cancer risk information outside of clinical genetics services are unknown. Methods: An exploratory sequential mixed-methods case-control study compared outcomes between women who did (cases; group 1) and did not (controls; group 2) receive clinically actionable genetic information from a research cohort in Victoria, Australia. Participants completed an online survey examining cancer risk perception and worry, and group 1 also completed distress and adaptation measures. Group 1 participants subsequently completed a semi structured interview. Results: Forty-five participants (group 1) and 96 (group 2) completed the online survey, and 31 group 1 participants were interviewed. There were no demographic differences between groups 1 and 2, although more of group 1 participants had children (p = 0.03). Group 1 reported significantly higher breast cancer risk perception (p < 0.001) compared to group 2, and higher cancer worry than group 2 (p < 0.001). Some group 1 participants described how receiving their genetic information heightened their cancer risk perception and exacerbated their cancer worry while waiting for risk-reducing surgery. Group 1 participants reported a MICRA mean score of 27.4 (SD 11.8, range 9–56; possible range 0–95), and an adaptation score of 2.9 (SD = 1.1). Conclusion: There were no adverse psychological outcomes amongst women who received clinically actionable germline information through a model of ‘genome-first’ care compared to those who did not. These findings support the return of clinically actionable research results to research participants.
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Ariail, Kiley, Carolyn (Cindy) Watts, and Deborah J. Bowen. "Retention in a Breast Cancer Risk Information Trial: Motivations of a Population-Based Sample of Women." Health Education & Behavior 33, no. 5 (2006): 591–603. http://dx.doi.org/10.1177/1090198106288493.
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A better understanding of factors influencing retention in breast cancer risk education and prevention programs can improve the design and effectiveness of such programs. Such information may also be useful to researchers seeking to maximize full retention in research trials involving low risk and low perceived benefit by the participants. These data are from a population-based study of 481 women from the Seattle, Washington, area, with diverse levels of breast cancer risk. This study sought to describe motivations for retention, to relate motivation variables to demographic characteristics, and to evaluate predictors of retention. Increasing age predicted study assessment completion, and both cancer worry and White ethnicity predicted intervention retention.
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Metsälä, Eija, Arja Pajukari, and Arja R. Aro. "Breast cancer worry in further examination of mammography screening - a systematic review." Scandinavian Journal of Caring Sciences 26, no. 4 (2011): 773–86. http://dx.doi.org/10.1111/j.1471-6712.2011.00961.x.
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Cameron, Linda D., and Jeanne Reeve. "Risk perceptions, worry, and attitudes about genetic testing for breast cancer susceptibility." Psychology & Health 21, no. 2 (2006): 211–30. http://dx.doi.org/10.1080/14768320500230318.
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Bradley, Patricia K. "The Delay and Worry Experience of African American Women With Breast Cancer." Oncology Nursing Forum 32, no. 2 (2005): 243–49. http://dx.doi.org/10.1188/05.onf.243-249.
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Gibbons, Andrea, and AnnMarie Groarke. "Can risk and illness perceptions predict breast cancer worry in healthy women?" Journal of Health Psychology 21, no. 9 (2016): 2052–62. http://dx.doi.org/10.1177/1359105315570984.
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Jang, Sou Hyun, Eun Jeong Lee, Jae A. Lim, Thuy Vu, Victoria M. Taylor, and Linda K. Ko. "The Role of Medical Tourism in Cancer Screening among Korean Immigrant Women." Health Behavior and Policy Review 6, no. 5 (2019): 522–33. http://dx.doi.org/10.14485/hbpr.6.5.10.
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Objective: Korean immigrant (KI) women have lower breast and cervical cancer screening rates than other Asian women subgroups. Medical tourism has emerged as a strong predictor for some types of cancer screening but has not been examined thoroughly with breast and cervical cancer screening. This study examines the association between medical tourism and breast and cervical cancer screening among KI women. Methods: Data came from a cross-sectional study examining health behaviors of KIs in the Seattle, Washington metropolitan area. Women ages 40-74 years were included in the analysis (N = 102). Outcomes were up-to-date with breast cancer screening and up-to-date with cervical cancer screening. Predictors included socio-demographics, health factors, acculturation, worry about cost of care, and medical tourism. Data analysis included logistic regression. Results: In multivariate modeling, medical tourism was the only predictor associated with both breast and cervical cancer screening. Women who engaged in medical tourism had greater odds of being up-to-date with breast cancer and cervical cancer screening respectively, compared to those not engaged in medical tourism. Conclusion: Many KI women are participating in medical tourism for cancer care. Our findings have broad implications for KI women in the US and their US providers.
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Miron-Shatz, Talya, Yaniv Hanoch, Glen M. Doniger, Zehra B. Omer, and Elissa M. Ozanne. "Subjective but not objective numeracy influences willingness to pay for BRCA1/2 genetic testing." Judgment and Decision Making 9, no. 2 (2014): 152–58. http://dx.doi.org/10.1017/s1930297500005519.
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AbstractA positive test result for BRCA1/2 gene mutation is a substantial risk factor for breast and ovarian cancer. However, testing is not always covered by insurance, even for high risk women. Variables affecting willingness to pay (WTP) have implications for clinic-based and direct-to-consumer testing. The relative impact of objective and subjective numeracy on WTP, in the context of worry, perceived risk (of having the mutation and developing breast cancer) and family history, was examined in 299 high-risk women, not previously tested for BRCA1/2. Objective and subjective numeracy correlated positively with one another, yet only subjective numeracy correlated (positively) with WTP. This could not be explained by educational level or worry. In line with the numeracy result, other objective factors including family history, age, and Ashkenazi descent were not correlated with WTP. Perceived risk of having a mutation was also correlated with WTP, though perceived risk of developing breast cancer was not, perhaps because it lacks direct connection with testing. Thus, subjective confidence in the ability to interpret test results and perceived risk of a positive test result are more important drivers in paying for BRCA1/2 testing than factors more objective and/or further removed from the testing itself (e.g., perceived risk of developing cancer, family history). Findings underscore the need for genetic counselling that makes probabilistic information accessible and intelligible, so as to build confidence and promote accurate perception of mutation risk and ultimately better decision-making.
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Li, Min, Jun Guo, Jinnan Gao, Linying Wang, and Yongxia Ding. "Qualitative study of the perceived experiences and needs coping of primary caregivers of patients with breast cancer during operation in central China." BMJ Open 13, no. 11 (2023): e072932. http://dx.doi.org/10.1136/bmjopen-2023-072932.
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PurposeThe purpose of this study is to gain an in-depth understanding of the intraoperative waiting period experience and needs response of primary caregivers of patients with breast cancer.MethodUsing a purposive sampling method, 16 primary caregivers of patients with breast cancer admitted to the Department of Breast Surgery of Shanxi Bethune Hospital from January to May 2022 were selected as study subjects. Semistructured in-depth interviews were conducted using a qualitative research method.ResultsFive themes were extracted from the levels of safety and security, information transfer, emotion management, psychological adjustment and role adaptation: safety first and intraoperative care, lack of information and misdirection, negative emotions and tired of coping, ineffective worry and overthinking, and role multiplicity and bearing alone, respectively.ConclusionThe intraoperative waiting period for primary caregivers of patients with breast cancer felt multidimensional and had less than optimal needs satisfaction. Healthcare professionals should use the existing needs as an entry point to give appropriate interventions to enhance the coping ability of caregivers of patients with breast cancer.