Attributions of cause and recurrence in long-term breast cancer survivors

Women are bombarded with information about the purported causes and the pre vention of breast cancer. This survey sought to determine to what women sur vivors of breast cancer attributed the cause and lack of recurrence of thei r breast cancer, and whether these views were associated with specific heal th behaviors. Methods: Women who had survived breast cancer without recurrence for at lea st 2 years were surveyed by mail about their views on the cause and lack of recurrence of their breast cancer. They were also asked to estimate their personal risk of cancer recurrence, report on their health behaviors, descr ibe what advice they would give to women newly diagnosed with breast cancer , and what they would change if they had to relive their breast cancer expe rience. Results: 378 (75.6%) women breast cancer survivors responded who had been r ecurrence free for a mean of 8.6 +/- 11.8 years. Women (n = 322) who respon ded to the question about the cause of breast cancer attributed it to stres s (42.2%), genetics (26.7%), environment (25.5%), hormones (23.9%), don't k now (16.5%), diet (15.5%), and breast trauma (2.8%). Women (n = 330) who re sponded to the question about what prevented cancer recurrence attributed i t to positive attitude (60.0%), diet (50.0%), healthy lifestyle (40.3%), ex ercise (39.4%), stress reduction (27.9%), prayer (26.4%), complementary the rapies(11.2%), don't know (5.1 %), luck (3,9%), and tamoxifen (3.9%). Most women felt their recurrence risk was average (44.8%), or below average (35. 8%). Some attributions of breast cancer cause or lack of recurrence were as sociated with specific health behaviors. The majority of women survivors wo uld advise other women with breast cancer to be positive, and if they had t o relive their cancer experience they would take more control of their trea tment. Discussion: Despite lack of evidence substantiating stress as a cause of br east cancer, many breast cancer survivors believed stress caused their canc er. An even higher percentage of survivors believed their positive attitude had prevented breast cancer recurrence and they would advise other women w ith breast cancer accordingly. Attribution beliefs clearly affected survivo rs' health behaviors. Conclusion: Healthcare providers should consider the personal beliefs of pa tients about cancer cause and recurrence, which may be at variance with sci entific evidence. This may assist in framing the management of patients in personally meaningful ways, which may increase health behaviors, adherence, satisfaction and quality of life. Whether it will increase survival remain s unknown. Copyright (C) 2001 John Wiley & Sons, Ltd.