The study proposed is designed to examine screening behaviors, (clinical breast examination (CBE), breast self-examination (BSE), and mammogram) in order to predict adherence to these behaviors in women who are at normal and high risk for breast cancer (based on family histories of breast cancer). Previous data on high risk women indicated that greater anxiety interfered with breast cancer screening behaviors (Kash et al, 1992). And data on normal risk women (Lerman et al, 1991) found that both high and low anxiety predicted poor screening adherence, while moderate levels of anxiety predicted good adherence.
The specific aims are: l) to determine differences in adherence to screening behaviors (BSE, CBE, mammogram) in two clinic cohorts (high and normal risk women); and 2) to examine the factors (health beliefs, normative influences/social support, knowledge and beliefs about breast cancer, coping strategies, locus of control, and psychological distress) that contribute to screening guideline adherence. The research is a quasi-experimental design to examine the screening behaviors of 200 women at high risk for breast cancer and 200 women at normal risk for breast cancer who attend breast protection programs. The total sample size of 400 will allow us to test our hypotheses. Data will be collected on demographic variables, risk status (both objective and subjective), all three screening behaviors, health beliefs, knowledge and beliefs about breast cancer, psychological variables (anxiety, distress, and mood), and psychosocial variables (locus of control, social supports and coping methods). Chi square and analysis of variance will be used for the major analyses in the first aim. Hierarchical logistic and multiple regression analyses will be used to examine main and interaction effects between the groups. Path analysis will be used to test causal modeling among several variables. This study provides the first opportunity to distinguish normal from high risk women on all three screening behaviors and separate out the important variables related to adherence to screening behaviors. The results will help identify segments within each group who need particular messages targeted to them. From this data, intervention strategies can be developed and tested to help women obtain information and coping methods useful in adhering to breast cancer screening behaviors.