Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, Brennan MacCallum Building (A18), Sydney, NSW, 2006, Australia.
Breast Cancer Res Treat. 2010 Nov;124(2):509-19. doi: 10.1007/s10549-010-0868-1. Epub 2010 Apr 4.
This study applied the self-regulation model to examine cognitive and emotional predictors of screening in unaffected women with a strong family history of breast cancer. 748 unaffected female members of an Australian registry of multiple-case breast cancer families formed the sample. Participants completed a baseline psychosocial questionnaire and a screening questionnaire 3 years later. Multinomial logistic regression was employed to determine predictors of under- and over-screening according to national guidelines. At follow-up 16% of women under-screened and 10% over-screened with mammography; 55% under-screened with clinical breast examination (CBE); and 9% over-screened with breast self-examination (BSE). Of the women found screening according to guidelines for mammography 72% reported ever having received specific recommendations for mammography screening from a health professional. Compared to appropriate screeners, under-screeners on mammography were less likely to have received a screening recommendation (as were under-screeners on CBE), were younger and reported lower perceived breast cancer risk, but were at higher relative risk (RR) of breast cancer and were more likely to report elevated depression. Over-screeners on mammography were more likely to be younger and have a lower RR of breast cancer. Over-screeners on BSE reported elevated cancer-specific anxiety, were less likely to be university educated and more likely to have received a recommendation for BSE. Under- and over-screening is common in women with a strong family history of breast cancer. Evaluation of interventions targeting perceived risk of breast cancer, anxiety and depression are needed to ensure women obtain accurate advice from relevant specialists and enact screening recommendations.
本研究应用自我调节模型，考察了认知和情绪因素对有强烈乳腺癌家族史的未受影响女性进行筛查的预测作用。该样本由澳大利亚多病例乳腺癌家族登记处的 748 名未受影响的女性成员组成。参与者在基线时完成了一份心理社会问卷，3 年后完成了一份筛查问卷。采用多项逻辑回归来确定根据国家指南预测未筛查和过度筛查的因素。在随访中，16%的女性进行乳房 X 光筛查不足，10%过度筛查；55%的女性进行临床乳房检查（CBE）不足筛查；9%的女性进行乳房自我检查（BSE）过度筛查。在根据指南进行乳房 X 光筛查的女性中，72%的人表示曾从医疗保健专业人员那里获得过关于乳房 X 光筛查的具体建议。与适当筛查者相比，乳房 X 光筛查不足者不太可能收到筛查建议（CBE 筛查不足者也是如此），她们更年轻，报告的乳腺癌风险较低，但乳腺癌的相对风险（RR）更高，并且更有可能报告抑郁程度升高。乳房 X 光筛查过度者更年轻，乳腺癌 RR 较低。BSE 筛查过度者报告了更高的癌症特异性焦虑，受教育程度较低，更有可能收到 BSE 检查的建议。在有强烈乳腺癌家族史的女性中，筛查不足和过度筛查很常见。需要评估针对乳腺癌感知风险、焦虑和抑郁的干预措施，以确保女性从相关专家那里获得准确的建议并实施筛查建议。
