Determinants of Mammography Screening Participation in Adult Childhood Cancer Survivors: Results From the Childhood Cancer Survivor Study

Cheryl L. Cox

Kevin C. Oeffinger

Michele Montgomery

Melissa M. Hudson

Ann C. Mertens

John Whitton

Les L. Robison

survivors, mammography
ONF 2009, 36(3), 335-344. DOI: 10.1188/09.ONF.335-344

Purpose/Objectives: To identify treatment, intrapersonal, and provider factors that influence childhood cancer survivors' adherence to recommended mammography screening.

Design: Secondary analysis of data derived from three consecutive surveys within the Childhood Cancer Survivor Study.

Sample: Female childhood cancer survivors: N = 335, X age = 30.92, X years after diagnosis = 21.79.

Methods: T tests and structural equation modeling.

Main Research Variables: Mammogram recency, health concerns, affect, motivation, and survivor-provider interaction.

Findings: Forty-three percent of the variance was explained in mammogram recency. Survivors most likely to follow the recommended mammogram schedule were directly influenced by cancer treatment exposure to mantle radiation (p = 0.01), less intrinsic motivation (p = 0.01), positive affect (p = 0.05), recent visits to an oncology clinic (p = 0.01), discussion of subsequent cancer risks with a physician (p = 0.001), perceptions of more severe late effects (p = 0.05), age (40 years or older) (p ≤ 0.001), and a print media intervention detailing breast cancer risks and follow-up strategies.

Conclusions: Perceived symptoms, motivation, affect, provider influences, readiness for medical follow-up, and knowledge of treatment exposures are potential modifiable targets for intervention to support mammography screening in childhood cancer survivors at risk.

Implications for Nursing: (a) Provide written summaries of treatment exposures and recommended schedule of mammography screening at the end of cancer treatment and throughout follow-up; (b) identify and address survivor symptoms and concerns that may negate screening; and (c) enhance motivation for screening by tailoring personal risk information to health concerns, affect, and readiness for follow-up.

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