Breast cancer worry, risk behavior higher among teenage girls

Teenage girls with a familial or genetic risk for breast cancer worry more about getting the disease, even when their mother has no history, compared to girls their age with no known high risks, according to new data presented today by researchers from Penn Medicine's Abramson Cancer Center at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago (Abstract #9527). Early analyses suggest that such worry may increase risk behavior, such as smoking and potentially alcohol use, but does not appear to influence positive behavior, such as exercise.

For the study, Angela Bradbury, MD, assistant professor of Medicine in the division of Hematology-Oncology at the Perelman School of Medicine at the University of the Pennsylvania, and colleagues from Penn Medicine and Fox Chase Cancer Center, evaluated psychosocial adjustments (cancer specific worry, anxiety and depression) and health behaviors in 320 girls aged 13 to 19 (208 were classified as high risk and 112 were classified as being at the general population risk). Girls were considered "high risk" if they had a parent with a BRCA1/2 mutation or at least one relative with a history of breast cancer. Girls were classified as "population risk" if they had a parent who tested true negative for a BRCA1/2 mutation or no family breast cancer history.

The study found that high-risk girls have significantly more worry around the disease than population-risk girls, even if mom has no history of the disease. There was no difference between the groups for general anxiety and depression. High-risk girls were also more likely to perceive their lifetime risk as higher than other girls their age at population risk (73 v. 32 percent). Interestingly, some population-risk girls also believe themselves to be at increased risk for breast cancer, particularly as they get older.

"Breast cancer worry in daughters who have mothers with breast cancer is well reported. But one of the most surprising findings from this study is that living within the context of a breast cancer family, regardless of whether mom has breast cancer or not, has an impact on these girls," said Bradbury. Another key finding was that a mother's worry and anxiety are strongly associated with her daughter's worry and anxiety. "More needs to be understood about this impact on psychosocial adjustment and health behaviors as girls transition to adulthood. The more we understand what young girls know about breast cancer risk—low or high risk—and how they perceive that information, the more likely we can help correct any misconceptions they may have and address their worry to benefit their development."

The study also revealed some differences in health behavior among both groups of girls (aged 13 to 19). High-risk girls were significantly more likely to smoke cigarettes. High risk girls were also more likely to try alcohol, although this difference was not statistically significant. Conversely, the analysis did not reveal significant differences in preventive behaviors, like exercise or self-exams among the girls. Though, high-risk girls were more likely to perform a self-breast exam and less likely to have ever had a clinical breast exam.

"Whether worry translates into greater risk-taking behaviors is a concern and the data suggests this possibility. This is a crucial time for development of behavior and a better understanding of the impact of awareness of breast cancer risk on development of health behaviors could provide opportunities to promote cancer preventive behaviors earlier," said Bradbury. "We need more research in order to fully understand how this knowledge affects these girls and their families in order to tailor interventions so we can optimize care and promote adaptive responses to breast cancer risk in girls and their mothers."

Bradbury presented the team's findings at ASCO on Monday, June 2, 2014 in the Patient and Survivor Care poster session from 8 a.m. to 11 a.m. in McCormick Place S102.