Anxiety and Adherence to Breast Self-Examination in Women With a Family History of Breast Cancer

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Abstract
Previous research has indicated low rates of adherence to monthly breast self-examination (BSE) in women with a family history of breast cancer, and anxiety has been identified as a major factor that may interfere with regular self-examination. However, the direction of the relationship between anxiety and BSE frequency remains unclear, with some studies indicating that high anxiety promotes adherence and others indicating that it leads to avoidance. The aim of the present study was to clarify the relationship between anxiety and adherence to breast self-examination by comparing the impact of general anxiety with that of cancer-specific anxiety on BSE frequency. A sample of at-risk women (N = 833) completed a questionnaire regarding BSE frequency, general anxiety, breast cancer worries, perceived risk of breast cancer, and family history of breast cancer. Women who self-examined infrequently (N = 211), appropriately (N = 462), or excessively (N = 156) were compared on these variables. Statistical analyses indicated that general anxiety differentiated only between excessive self-examiners and less frequent self-examiners, with excessive self-examiners reporting significantly higher general anxiety. Breast cancer worries differentiated between all three groups in a linear fashion, with increasing cancer worries associated with higher levels of BSE. In some at-risk women, high cancer anxiety may lead to high general anxiety and precipitate hypervigilant breast self-examination rather than avoidance. These findings are discussed in relation to psychoeducational interventions and genetic counseling services for women with a family history of breast cancer.