Allison Brandt Anbari

Awareness of alcohol consumption as a breast cancer risk remains limited among young adult women in the USA. This experiment (N = 1038) examined how female young adults aged 18–29 reporting past 30-day alcohol consumption responded to health warnings about the risk of alcohol for developing breast cancer. Structural equation modeling assessed associations between health warning exposure, binge-drinking frequency, negative affect, perceived threat of alcohol harms and behavioral intentions to reduce or stop drinking alcohol and seek information about alcohol health effects. Results found that exposure to health warnings elicited increased negative affect (β = .12, P < .001), which was associated with higher perceived threat of alcohol harms (β = .35, P < .001). Higher binge-drinking frequency was associated with increased negative affect (β = .21, P < .001) and perceived threat of alcohol harms (β = .13, P < .001). Finally, greater perceived threat of alcohol harms was associated with greater behavioral intentions to reduce drinking (β = .24, P < .001), stop drinking (β = .17, P < .001), seek information about alcohol harms (β = .34, P < .001), discuss alcohol harms with friends and medical professionals (β = .31, P < .001), and support policies for warnings on alcohol products (β = .15, P < .001). Findings suggest health warning designers should consider high-risk drinking patterns and develop warnings that influence affective reactions and related threat responses.

Purpose: Breast cancer survivorship care is complex and not always provided according to standards or guidelines. Likewise, current cancer survivorship care interventions and programming do not always underscore clinical practice guidelines (CPGs) in the same fashion as interventions for other conditions. A call for improvement in breast cancer survivorship care warrants re-evaluation of current breast cancer survivorship care CPGs. The purpose of this systematic review was to (1) characterize CPGs that include content clinically relevant to people with a history of breast cancer and (2) appraise the possibility of consolidating current CPGs to simplified topics to be presented as a potentially clinically applicable model of breast cancer survivorship care ( PROSPERO CRD42024591381 ). Methods: We conducted searches within six databases (PubMed, CINAHL, Scopus, PsycINFO, Cochrane DSR, and Cochrane Central), and in ProQuest Dissertations & Theses Global, ClinicalTrials.gov, and FigShare, Google, Google Scholar, and Bing. We located 3041 records to be screened and 191 records for full-text screening. Based on inclusion criteria considering clinical relevance to people with a history of breast cancer and AGREE II assessments, 21 records were included. We developed a codebook using the NCCN guidelines for cancer survivorship care. Results: Areas of concordance were identified as three consolidated topics: risk for recurrence, monitoring for new cancer, and fertility, reproductive, endocrine, and sexual health. These are underpinned by care coordination. Topics include main ideas derived from NCCN guidelines. We labeled each recommendation with main ideas that are more succinct, yet still inclusive/indicative of the full array of CPGs. Conclusion: We propose consideration and testing of our consolidated breast cancer survivorship care topics and main ideas. We hypothesize that our model could simplify breast cancer survivorship care provision in primary care settings.

Alcohol consumption increases breast cancer risk. We evaluated the responses of 748 United States female participants ages 21–29 to health warning messages addressing the relationship between alcohol consumption and increased breast cancer risk. In an online experiment, participants were randomly assigned to view standalone health warning messages about alcohol, breast cancer, and breast cancer health effects with varying picture and text attributes. Participants then completed post-message exposure assessments that included an immediate open-ended response to the message prompt. We conducted a qualitative content analysis of the responses and coded deductively based on constructs from the Message Impact Framework including message reactions, attitudes and beliefs, and behavioral intentions. These constructs and corresponding variables were present in participants’ responses. Response type did not vary by participants’ demographics or the attributes of the health warning message they viewed. The code new information was applied to 20% of the responses, indicating that those participants had no prior knowledge of alcohol and breast cancer risk. Alcohol and breast cancer messaging could impact drinking behaviors. Given the frequency of responses indicating a lack of awareness, more work in cancer prevention and population health messaging is warranted.

Background: Negative respiratory outcomes have been reported in people diagnosed with COVID-19. Breast cancer, the most common cancer diagnosed in women globally, is an important cancer to investigate regarding COVID-19 outcomes. We hypothesized that women with breast cancer and infected with COVID-19 would demonstrate a greater risk for negative respiratory outcomes than people without breast cancer. Objective: We sought to examine associations between breast cancer diagnosis, COVID-19 infection, and negative respiratory outcomes using an Oracle Real World dataset. Method: Horn and Gassaway’s Practice-Based Evidence Framework structured this retrospective cohort study. Regression analysis identified associations among negative respiratory outcomes and breast cancer and COVID-19 diagnosis. Associations between preexisting comorbidities and COVID-19 infection complications in the dataset were also examined. Results: Breast cancer and COVID-19 diagnoses significantly predict increased odds of developing a negative respiratory outcome (OR = 1.11, CI 1.01-1.23, P = .03). Additional predictors of negative respiratory outcomes include advanced age (OR = 4.88, CI 4.21-5.65, P < .001); Black race (OR = 1.19, CI 1.11-1.28, P < .001); history of emergency department visits (OR = 1.33, CI 1.27-1.40, P < .001); and history of respiratory illness (OR = 2.60, CI 2.41-2.81, P < .001). Race/ethnicity (Asian or Hispanic), age 20 to 34, and pre-index ischemic stroke or atrial fibrillation were not significantly associated with increased odds of negative respiratory outcomes. Conclusion: Black and older women with breast cancer are at increased risk of developing negative respiratory outcomes following a COVID-19 infection compared to younger and White women with breast cancer. Implications for clinical practice are discussed.

Purpose There is increased demand for lifestyle interventions earlier on the cancer continuum (i.e., during curative-intent treatment). To address this need, researchers face unique challenges intervening in the short period of time after diagnosis, but before initiation of chemotherapy and/or surgery. During the peak of the COVID-19 pandemic, transitions to remote/digital platforms became both mandatory and immediate. Methods This case study details the rapid transition to a remote/digital study embraced by our team as we recruited patients newly diagnosed with breast cancer to a pilot study. The pilot’s purpose was to characterize the relationships between physical activity (PA) and cognitive and mental health during breast cancer treatment. Results We reflect on the lessons learned during this pilot study with a particular focus on three emergent challenges: digital data collection, recruitment during active breast cancer treatment, and participant burden. We used a systematic implementation framework to track adaptations made to meet the evolving needs of patients and clinicians, while adhering to institutional protocols. Conclusions This case study provides important insights into the delicate balance between patient, clinician, and institutional needs in the breast cancer setting, particularly when delivering digital interventions during treatment. Implications for cancer survivors Careful attention should be paid to protocols for remote research to ensure that it is feasible, acceptable, and rigorous for all cancer survivors.

Background: This study sought to identify effective health warnings about alcohol consumption and breast cancer risk among young adult female participants.Methods: We tested a pool of health warnings in a national pilot study. We used the most effective designs from the pilot in the main experiment where young (ages 21–29) U.S. adult female participants (N = 1038) reporting past 30‐day alcohol consumption were randomly assigned into 1 of 4 conditions where they viewed a health warning about (1) mortality, (2) mastectomy, (3) hair loss, or (4) control (non‐health warning message). Participants were then randomly assigned to view 1 of 2 message types within each condition: text‐only or pictorial. Warnings were shown apart from products. Outcomes were message reactions (attention to and cognitive elaboration of warnings, fear, hope, and perceived message effectiveness), attitudes and beliefs (perceived severity and susceptibility to alcohol harms, and perceived response and self‐efficacy to prevent alcohol harms), and behavioral intentions to stop or to reduce alcohol consumption in the next month.Results: Multivariate analysis of covariance (MANCOVA) models testing between warning conditions showed estimated marginal means (EMM) for every health warning condition were significantly higher than the control for attention (control = 5.80 vs. mortality = 6.63, mastectomy = 6.81, hair loss = 6.83, all ps < 0.05), fear (control = 2.45 vs. mortality = 4.11, mastectomy = 4.16, hair loss = 4.02, ps < 0.05), perceived message effectiveness (control = 3.44 vs. mortality = 5.75, mastectomy = 5.82, hair loss = 6.09, ps < 0.05), and perceived severity of alcohol harms (control = 5.51 vs. mortality = 6.25, mastectomy = 6.09, hair loss = 6.35, ps < 0.05). There were no significant differences between the health warnings about cancer effects for perceived message effectiveness. EMMs for intentions to reduce alcohol consumption in the next month were significantly higher in the mortality (6.44) and hair loss (6.35) conditions versus control (5.61, ps < 0.05).Conclusion: Exposure to health warnings about alcohol consumption and breast cancer risk (vs. control) resulted in greater attention, fear, perceived message effectiveness, perceived severity of alcohol harms, and intentions to reduce alcohol consumption.

There are more than 4 million breast cancer survivors in the United States. With continuing improvements in early detection and treatment, the number of breast cancer survivors will only continue to increase. Breast cancer survivors face a lifetime risk of long-term or late-effects from cancer treatments, thus post-cancer treatment care, referred to as survivorship care, is critical. Social determinants of health, including where a breast cancer survivor lives, may impact cancer survivorship care. Our purpose was to evaluate the relationship between rural/urban status and receipt of cancer survivorship care and instructions for Missouri breast cancer survivors using state-level data from a nationwide telephone survey—the Behavioral Risk Factor Surveillance System (BRFSS). Missouri included the BRFSS Cancer Survivorship Module in 2014, 2016, 2018, and 2020. Module items ask cancer survivors about receipt of a “post-cancer-treatment summary” and “follow-up instructions.” We hypothesized chances of receipt of both components would differ among four level Rural–Urban Commuting Area (RUCA) Code groups (Rural, Small-Town, Micropolitan, Metropolitan). Data from 430 breast cancer survivors over four survey years were combined and grouped according to RUCA status. Using a logistic model with a multilevel approach (after sampling weights calibration), the relationship between receipt of survivorship instructions and RUCA group was examined. 46% of Missouri breast cancer survivors reported receipt of complete survivorship instructions. Compared to rural breast cancer survivors, micropolitan breast cancer survivors had 5.9 times higher odds of receiving survivorship instructions (p < 0.0001). Less than half of respondents reported receiving complete post-cancer treatment instructions. More urban respondents were more likely to receive instructions than their rural counterparts which raises questions about the quality of post-treatment care between rural and urban survivors. A sophisticated and purposeful approach to mitigating potential disparities is warranted. Receipt of cancer survivorship care plans may be impacted by rurality/urbanicity. Clinicians caring for cancer survivors living in rural or urban settings must continue to be diligent with providing personalized survivorship care.