Promoting breast self-exam in childhood cancer survivors

Childhood cancer treatment places female survivors at significantly greater risk of breast cancer than the general population. Breast self exam (BSE) is no longer recommended in the general population for women aged 40-69; however, the Children's Oncology Group recommends monthly BSE for childhood cancer survivors with both standard and high risk. This population's failure to practice BSE and/or to obtain provider exams is cause for concern.

The Interaction Model of Client Health Behavior (IMCHB) guided a secondary data analysis of a female (12-18 years) childhood cancer survivor subsample (n=149) from a longitudinal clinical trial on changing health behavior. The re-analysis documented the affect of the intervention (provision of breast cancer risk information and skill development in BSE) by comparing survivors' BSE practice frequency at baseline with their practice levels one year after exposure to the intervention; additionally the study sought to identify mediators and moderators of BSE practice as potential targets for intervention.

BSE practice frequency at the one-year follow-up was increased over baseline levels (p= <0.001); similarly, survivors' knowledge about their disease and treatment (p = 0.03), perceptions about the seriousness of treatment effects of cancer (p = 0.04), general fears about cancer (p = 0.04), and perceptions about needing to change their behavior (p = <0.001) increased. Controlling for baseline BSE practice frequency, lower levels of parental education (p = 0.02) and fear of cancer relapse (p = 0.05) predicted increased BSE frequency at follow-up. Lack of motivation (perceptions of not needing to change behavior and no commitment to health practices) (p = 0.03) predicted lower BSE practice frequency at follow-up.

While the intervention was effective in increasing BSE practice frequency, variables that mediated and/or moderated the impact of the intervention were also identified. Tailoring intervention approaches that consider patient background variables, address affective arousal (fear, worry), and enhance and support motivation may be key to promoting behavior change for earlier detection of breast cancer in this vulnerable population.