摘要：Objectives. We examined the strength of association between family history of breast cancer and family history of other cancers with breast cancer risk perception and repeat mammography. Methods. The sample included 6706 women, aged 46 to 74 years, with no breast cancer history. Multinomial logistic regression assessed the association between family history of cancer and breast cancer risk perception. Structural equation modeling estimated the relationship between family history of cancer and repeat mammography. Results. Breast cancer risk perception was strongly associated with family history of breast cancer in the mother or mother and sister (odds ratio [OR] = 32.15; P < .001); family history of breast cancer in the sister, daughter, or male first-degree relative (OR = 6.6–8.4; P < .001); and maternal history of other cancers (OR = 1.38–2.73; P < .001). For repeat mammography, women with maternal history of breast cancer had a mean increase of 0.50 more mammograms in the past 6 years compared with women without maternal history of breast cancer ( P < .001). Conclusions. Breast cancer risk perception was associated with the type of cancer found in first-degree relatives and with the person’s relationship to the family member with cancer. Family history of breast cancer affected repeat mammography behavior. Estimated to be diagnosed in 1 of every 8 women in their lifetime, breast cancer continues to present a public health concern. 1 Secondary prevention in the form of screening mammography has been shown to be the most effective population-wide approach to reducing the morbidity and mortality associated with breast cancer, 2–7 and studies indicate that each year of delay between screening mammograms decreases the life-sparing potential of screening by approximately 33%. 2,4–7 Lower breast cancer morbidity and mortality are associated with repeat mammography. Because delays between screenings can affect the efficacy of mammography screening programs, it becomes important to understand the overall pattern of women’s mammography use—the question is not only whether a woman had a mammogram, nor when was her last mammogram, but rather, has she been having mammograms at regular intervals since she was eligible for routine screening? Has she established a behavioral pattern of repeat mammography? Studies on repeat mammography, using medical records, have shown that the majority of eligible women are not screened annually. In one of the largest studies of its kind, Blanchard et al. 2 found that over a 10-year period only 6% of women received all annual mammograms. The mean number of mammograms was 5.06, consistent with the new United States Preventive Service Task Force recommendations, but half that of most screening guidelines at the time of the study. 2,8 When these results were stratified by age, race/ethnicity, zip code, income, language, insurance status, previous screening use, and medical history, no grouping of women showed a propensity toward repeat annual screening. 2 These results were echoed in 2 other studies using medical records to ascertain levels of repeat mammography over a minimum of 5 years: 16% in women aged 50 to 74 years enrolled in a health maintenance organization in Michigan 9 and 30% in women aged 65 years and older enrolled in the California Fee-for-Service Medicare plan 10 received 5 mammograms in a 5-year period. In attempting to increase participation in a health behavior (in this case, mammography), health behavior theorists often include the concept of risk perception or constructs related to risk perception in their frameworks. Because risk perception is a subjective judgment made at an individual level regarding the characteristics and severity of a risk, the framework of this research relies on both a psychological and public health approach. The psychological (individual) approach is based on early psychometric research by Tversky and Kahneman, 11 who identified heuristics that individuals rely on when making judgments of the comparative risk of an event, including availability (events that are easily brought to mind), anchoring (anchoring the known information to the unknown), and threshold effect (determining how much of a risk reduction is worthwhile). The public health approach relies on the concept of risk perception or susceptibility found in multiple health behavior models, including, but not limited to, the health belief model, 12 protection motivation theory, 13 the self-regulation model, 14 the theory of reasoned action, 15 the theory of planned behavior, 16 and expected utility theory. 17 Multiple studies indicate that family history of breast cancer is the risk factor that women base their own risk perception on. 18–20 However, breast cancers resulting from familial or genetic predisposition are thought to account for only 15% to 20% of all diagnosed cases; this means that 80% to 85% of breast cancers are occurring in women with no family history of the disease. Overreliance on family history of breast cancer to determine one’s own breast cancer risk may skew not only breast cancer risk perception, but may also affect rates of repeat mammography screening. Given the importance that women place on family history of breast cancer, the aim of this research was to determine the strength of the relationship between family history of breast cancer and family history of cancer other than breast cancer to perceived risk of developing cancer and to repeat mammography. It was hypothesized that differences in risk perception were associated with a family history of breast cancer, and that a family history of breast cancer predicted increased repeat mammography. The results might serve to elucidate the role family history of cancer plays in secondary prevention of breast cancer.
