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Access Type

Open Access

Document Type


Degree Program

Public Health

Degree Type

Master of Science (M.S.)

Year Degree Awarded


Month Degree Awarded



breast cancer, survivors, recurrence, behavior change, oncology


Over one third of breast cancer survivors report “fear of recurrence” as the primary concern after diagnosis and treatment. Behavior changes such as exercise and weight loss post cancer may reduce recurrence risk. How perceived recurrence risk affects behavior change is unknown. We evaluated this association in the Breast Cancer Survivorship Study, a cross-sectional study of 301 breast cancer survivors. Data on perceived recurrence risk (local and distant) and health behavior change (alcohol, exercise, nutrition, smoking, sun exposure, supplement use, weight) were assessed by mailed questionnaire. Multivariable logistic regressions were used to evaluate associations between perceived recurrence risk and health behavior change, and multinomial logistic regression to assess direction of change. 47.6% of women perceived their local recurrence risk <10%, while 36.3% perceived distant between 10-30%. Participants mean age was 60 years and had predominantly early stage cancer. Over 90% of women reported making a behavior change. Significant associations were found between higher perceived recurrence risk and behavior changes of nutrition (OR 3.1, 95% CI 1.6-6.3) and sun exposure (OR 2.5, 95% CI 1.2- 5.0). Exploratory direction of change analyses found women with higher perceived recurrence risk were more likely to make positive changes in nutrition (OR 4.0, 95% CI 1.9-8.2) and sun exposure (OR 2.5, 95% CI 1.2-5.2). Overall, we found trends that women are likely to make specific behavior changes as their perceived recurrence risk increases. Findings provide a baseline for future research to identify survivors more likely to make behavior changes that affect their long term health.


First Advisor

Katherine W. Reeves

Second Advisor

Susan R. Sturgeon

Included in

Epidemiology Commons