Pain, Distress and Mammography Use in Breast Cancer Patients

描述（由申请人提供）：乳腺癌是影响美国女性的主要癌症，也是女性癌症相关死亡的第二大原因。循证指南建议每年进行乳房X光检查，数据表明，每年进行乳房X光检查的早期发现可提高新发和复发乳腺癌的生存率。然而，研究表明，20%至55%的乳腺癌幸存者和一半没有癌症史的妇女不遵守乳房X光检查筛查指南。需要更好地了解预测持续使用乳房X线摄影的因素，以制定改善依从性和降低乳腺癌死亡率的策略。本申请包括两项研究。研究1建立在我们之前关于乳房X线摄影疼痛的研究基础上，重点关注接受保乳手术治疗（乳房肿瘤切除术）的女性。这项拟议的研究解决了一个关键的公共卫生问题-这些妇女乳房X光检查疼痛加剧是否会影响她们对可能挽救生命的筛查的坚持。研究2将我们的研究工作扩展到50岁及以上无癌症史的女性，以探索疼痛和痛苦对坚持筛查乳房X光检查的影响。这些研究将是第一个纵向研究，以评估疼痛，疼痛评估和乳房X光检查时的特定痛苦，并检查其对持续乳房X光检查依从性的影响。除了解决一个具有重要公共卫生意义的新研究问题外，拟议的研究还将包括一些创新的设计元素，包括在乳房X光检查时对女性进行真实的时间评估，以及最先进的疼痛测量、疼痛评估、乳房X光检查特定痛苦和健康行为理论变量。这些数据将使我们能够在考虑其他潜在的重要因素后，研究疼痛和痛苦对乳腺X线摄影依从性的影响。研究1将从两个互补的研究中心招募552名乳房肿瘤切除术后乳腺癌患者（N=276，杜克大学医学中心（DUMC）和N=276，匹兹堡大学医学中心（UPMC）），研究2将招募530名年龄50岁及以上无癌症史的女性（N=265，DUMC和N=265，UPMC）。评估将在乳房X光检查时在乳房X光检查诊所进行。在手术之前，女性将完成持续乳房疼痛，乳房X光检查特定痛苦，过去乳房X光检查经验，健康行为理论变量和心理症状的测量。手术后，妇女将完成乳房X光检查疼痛和疼痛评估的措施。将在30个月后确定对每年乳房X光检查的依从性（不包括癌症诊断/复发或建议进一步检查或间隔< 12个月进行乳房X光检查的女性）。拟议的研究有可能提供有价值的新信息，可以帮助：1）识别不太可能坚持每年乳房X光检查的女性，2）识别乳房X光检查期间疼痛和痛苦的高风险女性，3）制定策略以提高乳房X光检查的依从性并降低乳腺癌死亡率。公共卫生相关性：乳腺癌是影响美国女性的主要癌症，也是女性癌症相关死亡的第二大原因。每年通过乳房X光检查早期发现可提高新发和复发乳腺癌的存活率。然而，20%至55%的乳腺癌幸存者和一半没有癌症史的妇女没有定期接受乳房X光检查。该应用程序包括两项研究：研究1检查乳腺癌幸存者乳腺X线摄影依从性的预测因素，研究2检查50岁及以上无乳腺癌病史的女性乳腺X线摄影依从性的预测因素。这些研究将是第一个纵向研究，以评估疼痛，疼痛评估和乳房X光检查时的特定痛苦，并检查其对持续乳房X光检查依从性的影响。拟议的研究有可能提供有价值的新信息，可以帮助：1）识别不太可能坚持每年乳房X光检查的女性，2）识别乳房X光检查期间疼痛和痛苦的高风险女性，3）制定策略以提高每年乳房X光检查的依从性并降低乳腺癌死亡率。

DESCRIPTION (provided by applicant): Breast cancer is the leading cancer affecting women in the United States, and the second leading cause of cancer-related death among women. Evidence-based guidelines recommend annual mammography and data suggest that early detection by annual mammography increases survival rates for new and recurrent breast cancer. Yet, studies indicate that 20% to 55% of breast cancer survivors and half of all women without a cancer history do not adhere to mammography screening guidelines. A better understanding of the factors that predict sustained mammography use is needed to develop strategies for improving adherence and reducing breast cancer mortality rates. This application includes two studies. Study 1 builds on our previous studies of mammography pain by focusing on women who received breast conserving surgical treatment (lumpectomy). The proposed research addresses a critical public health issue - does heightened mammography pain in these women impact their adherence to potentially life saving screening. Study 2 extends our research efforts to women age 50 and over with no cancer history to explore the impact of pain and distress on adherence to screening mammograms. These studies will be the first longitudinal studies to assess pain, pain appraisal, and mammography specific distress at the time of mammography and examine their impact on sustained mammography adherence. In addition to addressing a novel research question with important public health implications, the proposed studies will include a number of innovative design elements, including real time assessment of women at the time of their mammogram and state-of-the-art measures of pain, pain appraisal, mammography specific distress, and health behavior theory variables. These data will allow us to examine the impact of pain and distress on mammography adherence after accounting for other potentially important factors. Study 1 will recruit 552 post-lumpectomy breast cancer patients from two complementary sites (N=276 at Duke University Medical Center (DUMC) and N=276 at University of Pittsburgh Medical Center (UPMC) and Study 2 will recruit 530 women age 50 and over with no cancer history (N=265 at DUMC and N=265 at UPMC). Assessments will be conducted in the mammography clinic at the time of mammogram. Prior to the procedure, women will complete measures of ongoing breast pain, mammography specific distress, past mammography experience, health behavior theory variables, and psychological symptoms. Following the procedure, women will complete measures of mammography pain and pain appraisal. Adherence to annual mammography will be determined 30 months later (excluding women with cancer diagnosis/recurrence or recommendation for further testing or mammograms at < 12 month intervals). The proposed studies have the potential to provide valuable, new information that can aid in: 1) identifying women who are less likely to adhere to annual mammography, 2) identifying women at high risk for pain and distress during mammography, and 3) developing strategies to improve adherence to mammography and reduce breast cancer mortality. PUBLIC HEALTH RELEVANCE: Breast cancer is the leading cancer affecting women in the United States, and the second leading cause of cancer-related death among women. Early detection by annual mammography increases survival rates for new and recurrent breast cancer. Yet, 20% to 55% of breast cancer survivors and half of all women without a cancer history do not undergo regular mammograms. This application includes two studies: Study 1 examines predictors of mammography adherence in breast cancer survivors and Study 2 examines predictors of mammography adherence in women age 50 and over who have no breast cancer history. These studies will be the first longitudinal studies to assess pain, pain appraisal, and mammography specific distress at the time of mammography and examine their impact on sustained mammography adherence. The proposed studies have the potential to provide valuable, new information that can aid in: 1) identifying women who are less likely to adhere to annual mammography, 2) identifying women at high risk for pain and distress during mammography, and 3) developing strategies to improve adherence to annual mammography and reduce breast cancer mortality.