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.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA131148-05
Application #
8408706
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Breslau, Erica S
Project Start
2009-01-01
Project End
2014-12-31
Budget Start
2013-01-01
Budget End
2014-12-31
Support Year
5
Fiscal Year
2013
Total Cost
$388,803
Indirect Cost
$87,115
Name
Duke University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Edmond, Sara N; Shelby, Rebecca A; Keefe, Francis J et al. (2017) Persistent Breast Pain Among Women With Histories of Breast-conserving Surgery for Breast Cancer Compared With Women Without Histories of Breast Surgery or Cancer. Clin J Pain 33:51-56
Edmond, Sara N; Keefe, Francis J (2015) Validating pain communication: current state of the science. Pain 156:215-9
Syrjala, Karen L; Jensen, Mark P; Mendoza, M Elena et al. (2014) Psychological and behavioral approaches to cancer pain management. J Clin Oncol 32:1703-11
Starkweather, Angela R; Sherwood, Paula; Lyon, Debra E et al. (2014) Depressive symptoms and cytokine levels in Serum and Tumor Tissue in patients with an Astrocytoma: a pilot study. BMC Res Notes 7:423
Keefe, F J; Porter, L; Somers, T et al. (2013) Psychosocial interventions for managing pain in older adults: outcomes and clinical implications. Br J Anaesth 111:89-94
Schroeder, David; Korsakov, Fedor; Jolton, Joseph et al. (2013) Creating widely accessible spatial interfaces: mobile VR for managing persistent pain. IEEE Comput Graph Appl 33:82-9
Keefe, Francis J; Wren, Anava A (2013) Optimism and pain: a positive move forward. Pain 154:7-8
Keefe, Francis J; Huling, Dane A; Coggins, Michael J et al. (2012) Virtual reality for persistent pain: a new direction for behavioral pain management. Pain 153:2163-6
Abernethy, Amy P; Wheeler, Jane L; Courtney, Paul K et al. (2011) Supporting implementation of evidence-based behavioral interventions: the role of data liquidity in facilitating translational behavioral medicine. Transl Behav Med 1:45-52
Keefe, Francis J (2011) Behavioral medicine: a voyage to the future. Ann Behav Med 41:141-51

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