Florida Atlantic University Christine E. Lynn College of Nursing, 777 Glades Road, Boca Raton, FL, 33431, USA.
Feinberg School of Medicine, Northwestern University, Arkes Family Pavilion Suite 600, 676 N Saint Clair, Chicago, IL, 60611, USA.
Breast Cancer Res Treat. 2018 May;169(1):141-152. doi: 10.1007/s10549-018-4674-5. Epub 2018 Jan 20.
This study examined clinical breast exam (CBE) and mammography surveillance in long-term young breast cancer survivors (YBCS) and identified barriers and facilitators to cancer surveillance practices.
Data collected with a self-administered survey from a statewide, randomly selected sample of YBCS diagnosed with invasive breast cancer or ductal carcinoma in situ younger than 45 years old, stratified by race (Black vs. White/Other). Multivariate logistic regression models identified predictors of annual CBEs and mammograms.
Among 859 YBCS (n = 340 Black; n = 519 White/Other; mean age = 51.0 ± 5.9; diagnosed 11.0 ± 4.0 years ago), the majority (> 85%) reported an annual CBE and a mammogram. Black YBCS in the study were more likely to report lower rates of annual mammography and more barriers accessing care compared to White/Other YBCS. Having a routine source of care, confidence to use healthcare services, perceived expectations from family members and healthcare providers to engage in cancer surveillance, and motivation to comply with these expectations were significant predictors of having annual CBEs and annual mammograms. Cost-related lack of access to care was a significant barrier to annual mammograms.
Routine source of post-treatment care facilitated breast cancer surveillance above national average rates. Persistent disparities regarding access to mammography surveillance were identified for Black YBCS, primarily due to lack of access to routine source of care and high out-of-pocket costs.
Public health action targeting cancer surveillance in YBCS should ensure routine source of post-treatment care and address cost-related barriers. Clinical Trials Registration Number: NCT01612338.
本研究调查了长期年轻乳腺癌幸存者（YBCS）的临床乳房检查（CBE）和乳房 X 线照相术监测情况，并确定了癌症监测实践的障碍和促进因素。
通过对全州范围内、随机选择的、诊断为 45 岁以下浸润性乳腺癌或导管原位癌的 YBCS 进行的一项自我管理调查，收集数据。研究对象按种族（黑人与白种人/其他）分层。多变量逻辑回归模型确定了每年进行 CBE 和乳房 X 线照相术的预测因素。
在 859 名 YBCS（n=340 名黑人；n=519 名白种人/其他；平均年龄 51.0±5.9 岁；诊断时间 11.0±4.0 年前）中，大多数（>85%）报告了每年进行一次 CBE 和乳房 X 线照相术。与白种人/其他 YBCS 相比，研究中的黑人 YBCS 每年进行乳房 X 线照相术的比例较低，且获得医疗服务的障碍更多。有常规医疗服务来源、有信心使用医疗保健服务、家庭成员和医疗保健提供者期望进行癌症监测、以及遵守这些期望的动机是每年进行 CBE 和乳房 X 线照相术的重要预测因素。缺乏获得医疗服务的机会是阻碍每年进行乳房 X 线照相术的一个重要障碍。
常规的治疗后医疗服务来源促进了乳腺癌监测，使其高于全国平均水平。针对黑人 YBCS 的乳房 X 线照相术监测持续存在差异，主要原因是缺乏常规医疗服务来源和高昂的自费费用。
针对 YBCS 的癌症监测的公共卫生行动应确保常规的治疗后医疗服务来源，并解决与成本相关的障碍。临床试验注册号：NCT01612338。
