Lerman C, Daly M, Sands C, Balshem A, Lustbader E, Heggan T, Goldstein L, James J, Engstrom P
Fox Chase Cancer Center, Cheltenham, PA 19012.
J Natl Cancer Inst. 1993 Jul 7;85(13):1074-80. doi: 10.1093/jnci/85.13.1074.
Previous studies estimate that first-degree relatives of women with breast cancer have a twofold to 10-fold increased risk of developing breast cancer. Recently, attention has focused on the mammography screening practices of women who are at high risk for breast cancer.
Our purpose was to characterize mammography screening practices in a sample of first-degree relatives of breast cancer patients and to identify variables that may serve as barriers to or facilitators of adherence to mammography.
Cross-sectional (rather than prospective) data were collected by telephone interviews with 140 women aged 35-79 years who had a family history of breast cancer in at least one first-degree relative (mother, sister, or daughter). Data were recorded on mammography screening patterns, depression, stress impact, and breast cancer worries.
Women whose mammography history adhered to age-specific recommendations varied by age: 76% of first-degree 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), employment (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 age (P = .019), intrusive thoughts about breast cancer (P = .042), and breast cancer worries that interfered with daily functioning (P = .004). Multivariate analysis by logistic regression indicated that only breast 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 mammography adherence.
This study suggests that most women at high risk for breast cancer adhere to the recommended mammography screening guidelines of the National Cancer Institute. However, rates of adherence among high-risk women aged 50 years 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 women, particularly those with less formal education.
Prospective longitudinal studies are needed to validate the present findings and to evaluate the impact of psychoeducational interventions for women with affected first-degree relatives.
以往研究估计，乳腺癌女性患者的一级亲属患乳腺癌的风险增加了2至10倍。最近，人们的注意力集中在乳腺癌高危女性的乳腺X线筛查实践上。
我们的目的是描述乳腺癌患者一级亲属样本中的乳腺X线筛查实践情况，并确定可能成为乳腺X线检查依从性障碍或促进因素的变量。
通过电话访谈收集了140名年龄在35 - 79岁之间、至少有一位一级亲属（母亲、姐妹或女儿）有乳腺癌家族史的女性的横断面（而非前瞻性）数据。记录了乳腺X线筛查模式、抑郁、压力影响和乳腺癌担忧等数据。
乳腺X线检查历史符合特定年龄建议的女性比例因年龄而异：35 - 39岁的一级亲属中为76%，40 - 49岁的为86%，50岁及以上的为63%。在双变量分析中，教育程度（P = .001）、就业情况（P = .046）以及索引患者确诊后的时间（P = .044）与乳腺X线检查依从性显著正相关。与依从性负相关的变量包括年龄（P = .０19）、对乳腺癌的侵入性想法（P = .042）以及干扰日常功能的乳腺癌担忧（P = .004）。逻辑回归的多变量分析表明，只有乳腺癌担忧（比值比[OR] = 2.5；95%置信区间[CI] = 1.09 - 5.9）和教育程度（OR = 4.8；CI = 1.6 - 14.3）是乳腺X线检查依从性的显著独立预测因素。
本研究表明，大多数乳腺癌高危女性遵守了美国国立癌症研究所推荐的乳腺X线筛查指南。然而，50岁及以上高危女性的依从率并不理想；这些女性中只有63%接受了年度乳腺X线筛查，13%从未接受过筛查。乳腺癌担忧可能是高危女性乳腺X线检查依从性的障碍，尤其是那些受教育程度较低的女性。
需要进行前瞻性纵向研究来验证目前的研究结果，并评估针对有患病一级亲属的女性进行心理教育干预的影响。
