MAMMOGRAPHY ADHERENCE AND PSYCHOLOGICAL DISTRESS AMONG WOMEN AT RISK FOR BREAST-CANCER

Background: Previous studies estimate that first-degree relatives of w omen with breast cancer have a twofold to 10-fold increased risk of de veloping breast cancer. Recently, attention has focused on the mammogr aphy screening practices of women who are at high risk for breast canc er. Purpose: Our purpose was to characterize mammography screening pra ctices in a sample of first-degree relatives of breast cancer patients and to identify variables that may serve as barriers to or facilitato rs of adherence to mammography. Methods: Cross-sectional (rather than prospective) data were collected by telephone interviews with 140 wome n aged 35-79 years who had a family history of breast cancer in at lea st one first-degree relative (mother, sister, or daughter). Data were recorded on mammography screening patterns, depression, stress impact, and breast cancer worries. Results: Women whose mammography history a dhered to age-specific recommendations varied by age: 76% of first-deg ree relatives aged 35-39 years, 86% aged 40-49 years, and 63% aged 50 years or more. In bivariate analyses, level of education (P = .001), e mployment (P = .046), and time since diagnosis of the index patient (P = .044) were significantly and positively associated with mammography adherence. Variables associated negatively with adherence included ag e (P = .019), intrusive thoughts about breast cancer (P = .042), and b reast cancer worries that interfered with daily functioning (P = 004). MultivariAte analysis by logistic regression indicated that only brea st cancer worries (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.09-5.9) and education (OR = 4.8; CI = 1.6-14.3) were significant independent predictors of mammogaphy adherence. Conclusions: This stud y suggests that most women at high risk for breast cancer adhere to th e recommended mammography screening guidelines of the National Cancer Institute. However, rates of adherence among high-risk women aged 50 y ears and older are suboptimal; only 63% of these women received annual screening mammograms, and 13% had never been screened. Breast cancer worries may pose a barrier to mammography adherence among high-risk wo men, particularly those with less formal education. Implications: Pros pective longitudinal studies are needed to validate the present findin gs and to evaluate the impact of psychoeducational interventions for w omen with affected first-degree relatives.