Pain, Distress and Mammography Use in Breast Cancer Patients

摘要 乳腺癌是影响美国女性的主要癌症，也是导致女性死亡的第二大原因。 女性中与癌症有关的死亡。循证指南建议每年进行乳房X光检查， 提示每年通过乳房X光检查早期发现可提高新发和复发乳腺癌的存活率 癌然而，研究表明，20%至55%的乳腺癌幸存者和一半没有乳腺癌的妇女， 癌症病史不符合乳房X光检查筛查指南。更好地理解这些因素 需要预测持续使用乳房X光检查，以制定提高依从性和减少 乳腺癌死亡率。本申请包括两项研究。研究1建立在我们以前的研究基础上， 通过关注接受乳房保留手术治疗（乳房肿瘤切除术）的女性， 这项拟议中的研究解决了一个关键的公共卫生问题--在这些患者中， 妇女影响其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，探讨疼痛和痛苦对坚持 筛查乳房X光片这些研究将是第一个纵向研究，以评估疼痛，疼痛评估， 乳房X光检查时的具体苦恼，并检查其对持续的影响 乳房X光检查依从性。除了解决一个新的研究问题与重要的公共卫生 影响，拟议的研究将包括一些创新的设计元素，包括真实的时间 评估妇女在乳房X光检查时的疼痛，疼痛评估， 乳房X光检查特定的痛苦，和健康行为理论变量。这些数据将使我们能够检查 在考虑了其他潜在的重要因素后，疼痛和痛苦对乳腺X线摄影依从性的影响 因素研究1将从两个互补部位招募552名乳房肿瘤切除术后乳腺癌患者（N=276 在杜克大学医学中心（DUMC），N=276在匹兹堡大学医学中心（UPMC）， 研究2将招募530名年龄在50岁及以上、无癌症史的女性（DUMC时N=265，DUMC时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。之前 程序，妇女将完成持续的乳房疼痛，乳房X光检查特定的痛苦，过去的措施， 乳房X光检查经验、健康行为理论变量和心理症状。后 在这一过程中，妇女将完成乳房X光检查疼痛和疼痛评估的措施。遵守年度 30个月后将确定乳房X光检查结果（不包括癌症诊断/复发或 建议在< 12个月的间隔进行进一步的测试或乳房X光检查）。拟议的研究包括 有可能提供有价值的新信息，有助于：1）确定不太可能 坚持每年进行一次乳房X光检查，2）在乳房X光检查期间确定疼痛和痛苦风险高的妇女， 以及3）制定策略，以提高对乳房X光检查的依从性并降低乳腺癌死亡率。

ABSTRACT 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.