Psychological aspects of cancer screening in high‐risk populations*

Abstract

Background The focus of this paper is to define who is at high risk for breast cancer and the psychological issues in breast cancer screening. Within this context, the emphasis is on secondary malignancies after treatment for childhood cancers, including age appropriate guidelines for cancer screening. While there have been no studies of distress in women at high risk for breast cancer related to childhood cancer treatments, we can extrapolate from this study of women at high risk for breast cancer because of genetic susceptibility. Methods Three hundred and ninety one women at increased risk for developing breast cancer from rural and urban areas of the United States completed a questionnaire regarding genetic testing, psychological distress, and health beliefs. They were compared with 382 age-matched controls, from the same geographical areas, with no family history of breast cancer in a first degree relative. Results A multiple regression analysis revealed that the best predictors of willingness to undergo genetic testing were: greater perception of being a gene mutation carrier, fewer negative and more positive aspects to testing, being at higher risk for breast cancer, and greater breast cancer anxiety (30% of variance). Conclusions Greater anxiety increased interest in testing but decreased adherence to screening behaviors. Women who have had childhood cancers with chest radiation treatment are at higher risk for breast cancer. The information gleaned from this study can be adapted to help them learn their real risk for developing breast cancer and to understand the importance of screening in the early detection of breast cancer. Med. Pediatr. Oncol. 36:519–524, 2001.