PURPOSE:  The young female childhood cancer survivor is at significant risk for breast cancer as a second neoplasm.  While breast self-exam (BSE) is no longer recommended for the general population, for the childhood cancer survivor it may be a life-extending intervention.  The purpose of this secondary analysis was to evaluate the impact of a multi-component health education intervention on the frequency of young survivors’ BSE practices, and to identify those factors which support or impede BSE. 

METHODS:    We completed a secondary analysis of data derived from a longitudinal, randomized controlled trial; the original study targeted increasing the practice of multiple health-protective behaviors, while simultaneously decreasing the practice of multiple health-risk behaviors in survivors of childhood cancer (n=267).  Since the entire female sub-sample (n=148) was exposed to the BSE skills and risk information components of the intervention, paired t-tests were used to evaluate the impact of the intervention on BSE practice frequency.  Structural equation modeling was used to identify the simultaneous impact of intrapersonal (knowledge, beliefs, motivation, affect {worry/concern}) and contextual factors (demographic and social influences) that facilitate or impede the practice of breast self-exam in young female childhood cancer survivors.

FINDINGS:  Frequency of breast self-exam (t=-5.098, df=143, p≤ 0.0001) increased between T₀ and T₁.  Structural equation models (RMSEA = <0.01 with all parameters significant p=<0.05) identify demographic, affective, and motivational influences on the practice frequency of BSE at T₀ and T₁ in female childhood cancer survivors.

DISCUSSION:  Based on these study findings, we offer profiles of young female childhood cancer survivors who are most likely not to practice BSE, thereby becoming targets for intensive intervention during late cancer therapy and follow-up.  Strategies for enhancing survivors’ late treatment motivation and skill to perform BSE will be addressed.