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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
Leslie L. Robison
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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