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    Why Some Breast Cancer Survivors Do Not Use Surveillance Mammography

    Scientific Abstract:
    Women with a history of primary unilateral breast cancer have a 5-year risk of contralateral breast cancer approaching 4%. Risk of local recurrence is 5-10% at five years and increases to 10-15% at 10 years. To promote early detection of new and recurring breast cancers and improve survival, professional organizations recommend annual mammographic surveillance and clinical breast examination for women with a history of breast cancer. Most breast cancer survivors return for surveillance mammography after the diagnosis and treatment. But previous research has shown that not all women who have experienced breast cancer utilize surveillance mammography. About 15% of women living in Vermont (and elsewhere) do not return for surveillance mammography between 7 and 30 months after their diagnosis. Previous research suggests several reasons why some women are not receiving surveillance mammography. These include age, type of treatment, type of treating physician, stage at diagnosis and co-morbidity. Most previous research has been conducted with data from large administrative databases. Researchers using these data have not had the opportunity to ask the breast cancer survivor directly about psychological factors such as anxiety or risk perception. This study proposes to conduct telephone interviews with breast cancer survivors who did not return for mammography and a matched group of women who did return for mammography after breast cancer. The study will examine the differences in demographic, psychological, physical and health care issues between the two groups of women. Because follow-up mammography surveillance behavior of all study participants is known through the Vermont Breast Cancer Surveillance System, demographic, psychological, physical and health care variables will be included in univariate and multivariate analyses to identify factors predictive of women returning for mammography (yes/no). The results of this study will enable us to identify the women who are at risk of not returning for surveillance mammography and to plan appropriate interventions for breast cancer survivors to encourage the use of mammographic surveillance.

    Lay Abstract:
    Women who have experienced breast cancer in one breast are at higher risk for breast cancer in the other breast and for a recurrence in the same breast if breast conserving surgery has been performed. The best methods for identifying new or recurring breast cancer are annual mammography and clinical breast examination as recommended by several professional organizations. Most breast cancer survivors return for surveillance mammography after the diagnosis and treatment of breast cancer. However, about 15% of women living in Vermont (and elsewhere) do not return for surveillance mammography between 7 and 30 months after their diagnosis. Previous research suggests several reasons why some women are not receiving surveillance mammography. These include age, type of treatment, type of treating physician, stage at diagnosis and co-morbidity. Most previous research has been conducted with data from large administrative databases. Researchers using these data have not had the opportunity to ask the breast cancer survivor directly about psychological factors such as anxiety or risk perception. This study proposes to conduct telephone interviews with breast cancer survivors who did not return for mammography and a group of women who did return for mammography after breast cancer to learn the differences in demographic, psychological, physical and health care issues between the two groups of women. Women will be identified through the Vermont Breast Cancer Surveillance System database and we will know if they have returned for surveillance mammography from the same source of information. The results of this study will enable us to identify the women who are at risk of not returning for surveillance mammography and to plan appropriate interventions for breast cancer survivors to encourage the use of mammographic surveillance.