Consequences Of Breast Cancer Research Articles

Variation Analysis in Premenopausal and Postmenopausal Breast Cancer Cases.

Menopausal status affects the prognoses and consequences of breast cancer. Therefore, this retrospective study aimed to reveal the molecular variation profile differences in breast cancer patients according to their menopausal status, with the hypothesis that the molecular variation profiles will be different at premenopausal and postmenopausal ages. Breast cancer patients (n = 254) who underwent molecular subtyping and QIAseq Human Breast Cancer NGS Panel screening between 2018 and 2022 were evaluated retrospectively. Their menopausal status was defined by age, and those aged 50 years and above were considered postmenopausal. Of the subjects, 58.66% (n = 149) were premenopausal and 41.34% (n = 105) were postmenopausal. The mean age at the time of diagnosis for all patients was 49.31 ± 11.19 years, with respective values of 42.11 ± 5.51 and 59.54 ± 9.01 years for the premenopausal and postmenopausal groups, respectively (p = 0.000). Among premenopausal patients, the percentages of patients in BCa subtypes (luminal A, luminal B-HER2(-), luminal B-HER2(+), HER2 positive, and triple-negative) were determined to be 34.90%, 8.05%, 26.17%, 10.74%, and 20.13%, respectively, while in the postmenopausal group, these values were 39.05%, 16.19%, 24.76%, 6.67%, and 13.33%, respectively (p > 0.05). Considering menopausal status, the distribution of hormone receptors in premenopausal patients was ER(+)/PgR(+) 63.76%, ER(-)/PgR(-) 23.49%, ER(+)/PgR(-) 10.74%, and ER(-)/PgR(+) 2.01%, respectively, while in postmenopausal women, this distribution was observed to be 74.29%, 23.81%, 1.90% and 0.00% in the same order (p = 0.008). The most frequently mutated gene was TP53 in 130 patients (51.18%), followed by PIK3CA in 85 patients (33.46%), BRCA2 and NF1 in 56 patients (22.05%), PTEN in 54 patients (21.26%), and ATR and CHEK2 in 53 patients (20.87%). TP53, PIK3CA, NF1, BRCA2, PTEN, and CHEK2 mutations were more frequently observed in premenopausal patients, while TP53, PIK3CA, BRCA2, BRCA1, and ATR mutations in postmenopausal patients. These findings contribute to a deeper understanding of the underlying causes of breast cancer with respect to menopausal status. This study is the first from Turkey that reflects the molecular subtyping and somatic mutation profiles of breast cancer patients according to menopausal status.

Lifestyle and Socioeconomic Transition and Health Consequences of Breast Cancer in the East Asia Region, From 1990 to 2019.

BackgroundDue to its higher prevalence and heterogeneity, female breast cancer (BC) is the widest disease throughout the world. We sought to assess the epidemiological and sociodemographic transitions of BC and to identify the potential risk factors attributed to burden of BC in East Asia.MethodsAt the regional level of East Asia and at a national level of East Asian countries, we investigated the burden of the incidence of female BC, mortality, and disability-adjusted life years (DALYs) in 2019 and assessed the epidemiological, socioeconomic, and health-linked disparities in incidence of BC and mortality over a 30-year period. The changes in BC’s mortality and DALYs between 1990 and 2019, attributable to varying risk factors, were evaluated in different age groups.ResultsIn 2019, the incidence of and mortality from and DALYs of BC were estimated to be 382,321 (95% UI: 303,308–477,173) incidence cases [age-standardized rate (ASR) of 35.69 per 100,000; 28.32–44.54], 98,162 (79,216–120,112) deaths (ASR of 9.12; 7.36–11.13), and 3,024,987 (2,477, 984–3,659,370) DALYs with an ASR of 282.15 (230.81–341.19) in 2019. It was also observed that out of four most representative locations of East Asia, two (China and Japan) showed more than 60% increase in age-standardized incidence rate between 1990 and 2019. While only Japan females showed a significant rise of 15.3% (95% UI: 2.3–28) in ASR of death and 12.6% (95% UI: 0.5–26.9) in ASR of DALYs between 1990 and 2019. Inclusively, 88 and 81% variations were explained in the incidence of BC and death due to change in sociodemographic index (SDI) in 2019, in East Asia. The highest positive percent changes in death and DALYs between 1990 and 2019 were attributable to high body mass index (BMI), high fasting plasma glucose (FPG), and alcohol consumption in East Asia.ConclusionThe burden of death and disability from female BC is the result of multiple risk factors, mainly due to behavioral and metabolic risk factors. The increase of the incidence is related to the westernized lifestyle and diet habits and the improvement of screening and diagnosis techniques in the recent years, whereas the increase in DALYs is mainly attributed to high BMI, high FPG, alcohol use, and high diet in red meat.

Abstract PS7-45: Insurance coverage, employment status, and financial wellbeing of young women diagnosed with breast cancer

Abstract Research Objective: The objective of this study was to evaluate the insurance, employment, and financial experiences of young (age ≤ 39 years) female breast cancer patients and assess factors associated with any changes in their financial situation. Previous literature has shown that younger women are more likely to be diagnosed with late-stage disease that requires more-intensive treatments, while significant medical expenditures, productivity losses, financial hardship, and changes in employment and work productivity have been found in patients of all ages. Methods: A sample of women who were diagnosed with breast cancer between the ages of 18 and 39 years and residing in the states of California, Florida, Georgia, and North Carolina were identified. The sample included women who were (1) diagnosed with ductal carcinoma in situ (D05.90; 8500/2) or invasive breast cancer (C50; 8500/3) between January 2013 and December 2014; (2) between the ages of 18 and 39 years at the time of diagnosis; and (3) alive at the time of data extraction. We contacted 3,659 women by mail; 2,927 were alive with deliverable addresses. Of those, 830 women returned completed surveys, yielding a response rate of 28.4%. The survey instrument included 66 questions on demographics, insurance status, employment history, out-of-pocket cost, and overall financial well-being. Multivariate analysis was used to identify factors associated with financial decline. Principal Findings: About half of the women (47.4%) reported that treatment expenditures were higher than anticipated, and almost two-thirds (65.3%) had not discussed treatment costs with their care team. Almost a third of the patients (31.8%) reported treatment nonadherence due to cost. Factors associated with not receiving recommended care included very young age (<35 years) at diagnosis, self-insurance, the presence of comorbid conditions, and a late-stage diagnosis. Conclusions: Young female breast cancer patients experienced considerable financial burden regardless of insurance coverage. Most respondents made employment decisions that would allow them to keep their health insurance coverage. Knowledge about the financial consequences of breast cancer can help patients factor cost and employment into treatment decisions. Implications for Policy or Practice: This study highlights the burdens that many young women with breast cancer face, regardless of employment or insurance status, raising the possibility of target policy intervention. The strengths of this study include a unique focus on young breast cancer patients, identification of patients from population-based cancer registries, and the utilization of multifaceted insurance/financial indicators. Citation Format: Florence Tangka, Sujha Subramanian, Madeleine Jones, Patrick Edwards, Tim Flanigan, Jenya Kaganova, Kevin Smith, Cheryll Thomas, Nikki Hawkins, Temeika Fairley, Gery Guy, Juan Rodriguez. Insurance coverage, employment status, and financial wellbeing of young women diagnosed with breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-45.

Post-traumatic stress symptoms and social constraints in the communication with family caregivers among Chinese-speaking breast cancer survivors.

The consequences of breast cancer on physical and psychological well-being have been extensively studied. One of the long-term effects of the disease is Post-Traumatic Stress Symptoms (PTSS). However, only a small number of studies examined PTSS among Chinese-speaking breast cancer survivors. This study investigated interpersonal and physical health predictors ofPTSS and explored sociodemographic and clinical factors linked to PTSS in this group. We hypothesized that higher levels of social constraints and lower levels of social support, relationship closeness, and physical health would be associated with higher levels ofPTSS. A sample of96 Chinese-speaking breast cancer survivors completed measures of PTSS, social constraints, social support, closeness, health-related quality of life, and acculturation. Bivariate correlation examined association between variables of interest. Then, a hierarchical multiple regression analysis was conducted to examine predictors of PTSS. Participants reported an average score of 14.7 (SD = 10.46, range 0-44) on the severity of PTSS, with 54.2% (N = 52) meeting the criteria for likelihood of PTSD. PTSS were positively associated with social constraints and negatively associated with social support, closeness, and physical health. More medication usage was linked to worse PTSS. Only social constraints in the ability to communicate cancer-related concerns to the caregiver predicted worse PTSS severity. The study unveils the role of interpersonal factors in mental health outcomes of Chinese-speaking breast cancer survivors. Future research should be conducted on larger samples and culturally relevant psychosocial interventions should be developed.

Abstract ES3-1: Brain metastases of breast cancer

Abstract Brain metastases are devastating consequences of breast cancer. Both the lesions and their treatments cause physical and neurocognitive complications. Translational investigations have provided several new insights into the brain metastatic process which are hoped to lead to new preventive and therapeutic approaches. First, DNA sequencing of matched primary tumors and brain metastases revealed that nearly half of the brain lesions harbor potentially actionable mutations not present in the primary tumor. Second, model systems reveal that brain metastatic colonization arises through a complex interplay between the tumor cells and their microenvironment. Astrocytes are found in the normal blood-brain barrier and activate and surround a developing metastasis. They have been reported to modulate metastatic growth via several pathways. Additional investigations have uncovered other mechanistic contributions from activated microglia and other cells. The blood-brain barrier is also a contributor to heterogeneous and insufficient uptake of drugs to brain metastases. When a metastasis forms, the blood-brain barrier is termed a blood-tumor barrier (BTB). Multiple facets of the BBB are altered in the BTB. Alterations to the sphingosine-1 phosphate receptor 3 (S1P3) pathway in neuroinflammatory astrocytes of the BTB functionally altered BTB permeability. These data indicate that the BTB is a tractable structure to improve drug uptake and efficacy. Finally, investigators have identified brain permeable drugs and hormonal therapies that prevent the development of brain metastases in models, and which stand as support for new trials. Citation Format: Steeg P. Brain metastases of breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr ES3-1.

The long-term financial consequences of breast cancer: a Danish registry-based cohort study

BackgroundA breast cancer diagnosis affects an individual’s affiliation to labour market, but the long-term consequences of breast cancer on income in a Danish setting have not been examined. The present study investigated whether breast cancer affected future income among Danish women that participated in the work force. We also examined the roles of sociodemographic factors and prior psychiatric medical treatment.MethodsThis registry-based cohort study was based on information retrieved from linked Danish nationwide registries. We compared the incomes of 13,101 women (aged 30–59 years) diagnosed with breast cancer (exposed) to those of 60,819 women without breast cancer (unexposed). Changes in income were examined during a 10-year follow-up; for each follow-up year, we calculated the mean annual income and the relative change compared to the income earned one year prior to diagnosis. Expected changes in Danish female income, according to calendar year and age, were estimated based on information from Statistics Denmark. For exposed and unexposed groups, the observed income changes were dichotomized to those above and those below the expected change in income in the Danish female population. We examined the impact of breast cancer on income each year of follow-up with logistic regression models. Analyses were stratified according to educational level, marital status, and prior psychiatric medical treatment.ResultsBreast cancer had a temporary negative effect on income. The effect was largest during the first three years after diagnosis; thereafter, the gap narrowed between exposed and unexposed cohorts. The odds ratio for an increase in income in the cancer cohort compared to the cancer-free cohort was 0.81 (95% CI 0.77–0.84) after three years. After seven years, no significant difference was observed between cohorts. Stratified analyses demonstrated that the negative effect of breast cancer on income lasted longest among women with high educational levels. Being single or having received psychiatric medical treatment increased the chance to experience an increase in income among women with breast cancer.ConclusionA breast cancer diagnosis led to negative effects on income, which ameliorated over the following seven years. Sociodemographic factors and prior psychiatric medical treatment might influence long-term consequences of breast cancer on income.

Community Based Psychosocial Education Can Improve Mood Disturbance in Breast Cancer Survivors at Various Stages of Their Recovery

Psychosocial distress can contribute to avoidance, refusal, or discontinuation of cancer treatment, which could impact recovery and survival. The aim of the present study was to evaluate the effectiveness of a community based psychosocial program on alleviating mood disturbance in breast cancer survivors at different stages of their breast cancer journey. A total of 37 women participated in an 8-week psychosocial program at their local community centre. The weekly 3-hour program was delivered in a small group format. Program components included health education, behavioural training, cognitive behavioural therapy, art therapy and stress-management. Questionnaires aimed at assessing psychiatric morbidity and mood adjustment were administered at the beginning of the program (Pre) and at the completion of the program (Post). Group data revealed a significant reduction in psychiatric morbidity and improved psychological adjustment. When participants were divided into degree of psychiatric morbidity (mild, moderate, severe, very severe) a significant reduction in the reporting of anxiety symptoms in the mild, moderate, severe and very severe groups was reported; depression symptoms in the severe and very severe groups were noted, and anger, confusion and somatic symptoms in the mild group were noted. The level of activity was also significantly improved in the very severe group. A structured community based psychosocial program is beneficial to women struggling to come to terms with the emotional consequences of breast cancer at all stages of recovery.

33 Long term consequences of breast cancer

33 Long term consequences of breast cancer

Abstract P2-11-11: Patient Reported Outcomes after Breast Cancer Surgery and Adjuvant Therapy from a German Breast Cancer Centre

Abstract Objectives: Evaluation of the subjectively experienced physical, psychological, social and job-related consequences of breast cancer. Methods: Standardized paper pencil interview of patients with the initial diagnosis of breast cancer who had their primary surgery between 01/2006 and 12/2010 at an accredited breast cancer centre followed by systemic adjuvant treatment. The data collection was conducted with the help of a self-developed scanner-readable questionnaire which had been evaluated in a pretest. Results: 1260 patients were contacted, 871 completed questionnaires (return rate 72%) were analyzed. Median age of the patients (99.5% women) at the time of the interview was 65 years (30–91). 6% relapsed during the observation period. 91% were “satisfied” or “very satisfied” with the surgical result. 67% indicated a complete freedom of pain. 23% received lymphatic drainage at the time of the questioning (11/2011), 33% complained about limitations of arm and/or shoulder function. 76% received anti-hormonal therapy, 13% stopped the anti-hormonal medication prematurely. Patients received a mean of 1.3 different anti-hormonal therapies, 54% took Tamoxifen. Psychological distress, cognitive limitations and physical consequences were rated on a scale from 1 – “not at all” to 4 – “very much”. The highest average values were found for the items sleep disturbances (2.3) and exhaustion (2.3), the lowest for depression (1.7) and word-finding difficulties (1.8). After therapy only 39% described a complete recovery of their physical capacity, 62% regained their previous mental capacity. 44% were in employment before their disease. 67% returned to their workplace but only 65% of them with their previous number of hours. 15% indicated disadvantages in their workplace due to the breast cancer disease. For 75% their partnership did not change, 12% experienced a deterioration, 13% an improvement. Before the illness 9% consulted a psychiatrist/psychotherapist, after the illness 18%. Before the diagnosis of breast cancer 13% received antipsychotic drugs, after the disease 25%. Conclusions: Breast cancer diagnosis and therapy leads to long lasting impairment of physical, psychological, social and job-related functioning in a significant number of patients. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-11.

Abstract ES4-1: Navigating the Obstacles and Risks of Survivorship: Breast Cancer Sexuality: Issues and Answers

Abstract The sexual consequences of breast cancer and its treatments are well known. Sexual difficulties include alteration in hormonal levels, changes in sexual organs and anatomy, vaginal and vulvar dryness, changes in libido, increased latency to orgasm and decreased intensity of orgasmic response. Changes in body image, sexual self-esteem and relationship dynamic tension may present as survivorship challenges for the breast cancer patient and her partner. Severe vulvo vaginal and clitoral atrophy as a result of chemotherapy and/or adjuvant hormone therapy, and loss of libido secondary to dyspareunia are widespread. Cytostatic medications that are prescribed for long-term use (aromatase inhibitors) can impact bone health, sexual functioning/satisfaction and overall quality of life. Many women on aromatase inhibitors have severe complaints of vulvar and vaginal atrophy. Sexual dysfunction is common for breast cancer population and limited acceptable treatments are available. Minimally absorbed local vaginal estrogen use in this population remains controversial and a hotly debated controversial topic. More data should be forthcoming. There are multiple new innovative treatments in the research pipeline for female sexual dysfunction. DHEA intravaginal suppositories, Flibanserin and Bremelanotide (PT 141) remain promising although they have not been adequately studied in the breast cancer population. Ospemifene a novel estrogen agonist/ antagonist has demonstrated a strong estrogenic effect on the vaginal epithelium during a three month trial period and did not stimulate the endometrium; however, the medication did mildly aggravate hot flashes (this did not lead to drug discontinuation). Although not studied in breast cancer patients, pivotal Phase 3 data confirmed effectiveness of ospemifene as effective treatment for vulvovaginal atrophy. In a recent article in Menopause, Ospemifene and 4-hydroxyospemifene effectively prevented and treat breast cancer in Mtag. TG Transgenic Mouse. Testosterone use remains off label and is not FDA approved, yet it is widely used in the non cancer population. New emerging safety data will be presented. Vaginal moisturizers, lubricants and dilators in association with genito pelvic floor therapy and intravaginal valium suppositories can be considered front line treatment for atrophy, dyspareunia and hypertonic vaginismus. New innovative data on non hormonal management of hot flashes is and important initial step in the overall management of the breast cancer patient who is suffering from sexual dysfunction. A multi model treatment paradigm will be presented which will include pharmacologic, nonpharmacologic, and psychosocial interventions. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr ES4-1.

IN21 “Mommy has breast cancer”: how do children cope? – Protecting: a grounded theory study of school-age children's experiences in the context of maternal breast cancer

Results: After breast cancer, the couple relationship is affected most by body image concerns, sexual symptoms and infertility related issues. 23 to 25% of women with breast cancer have to face a separation/divorce after the diagnosis, the younger presenting the higher vulnerability, versus 7% of relationships breakdown when men are affected by cancer. On “her” side, body image concerns may affect self-esteem, willingness to play a seductive role, feeling erotically assertive and confident, with changes in quality of foreplay, acceptance of nakedness and confidence in exposing the breast. Loss of sexual desire, arousal disorderswith vaginal dryness, dyspareunia, coital anorgasmia and loss of sexual satisfaction are progressively complained of, as sexual function tend to go worse over time. Age (the younger thewoman themore serious the impact), lymphedema, side-effects of surgery, radio/chemotherapy, hormonotherapy, and the cosmetic outcome may modulate the impact of breast cancer on the individual woman and couple. The highest vulnerability is reported in women affected by iatrogenic premature menopause with its cohort of symptoms, secondary to the chronic loss of estrogens, on the brain (depression, anxiety, irritability, memory concerns), on the pathophysiology of sexual response and on the function of the pelvic floor. Women on tamoxifen or aromatase inhibitors may complain of more severe menopausal and sexual symptoms. On “his” side, key issues include sexual dysfunction and dissatisfaction, infertility and the “burden” of looking after a family with children. Loss of estrogen may reduce the “scent of woman” and pheromones, which trigger the biological side of sex drive, and make penetration difficult because of vaginal dryness. Partners may complain of situational loss of desire, and/or of erectile deficit, when dryness itself challenges the quality of the erection or when he perceives vaginal dryness as a sign of refusal. Conclusion: The young couple is more vulnerable to the sexual consequences of breast cancer in comparison to older ones. A multidisciplinary and pragmatic approach to sexual complaints of breast cancer survivors should be offered to women and couples who desire to prevent the sexual consequences of the disease and/or get back to a better sexual intimacy. The presentation will review the (scarce) evidence, report women’s and couple wording and offer concrete suggestions to address the most frequently reported sexual issues and complaints.

Living into old age with the consequences of breast cancer

Purpose of the researchBreast cancer survival rates are improving with over 60% likely to live 20 years. As 30% diagnoses occur in women over 70 the prevalence of breast cancer survivors living into older age is increasing. The specific needs and experiences of this group have rarely been addressed. This study aimed to explore older women's experience of living with breast cancer alongside other health conditions, and to identify their information and support needs and preferences. Methods and sampleData were collected from 28 semi-structured qualitative interviews and 2 focus groups (n = 14), with breast cancer survivors aged 70–90, and were analysed using thematic analysis. Key resultsThese older breast cancer survivors experienced a range of long-term physical problems resulting from treatment, including poor cosmetic results and poor shoulder movements, and bras and prostheses were often unsuitable. Many were keen to preserve their body image ideal irrespective of age. Reconstruction was rarely discussed, but all would have liked this option. Older women wanted to be treated as individuals rather than uniformly as older people, with their personal physical and social needs (including co-morbidities) taken into account. They expressed a preference for information direct from health professionals. ConclusionsMany breast cancer survivors will live into advanced old age with permanent physical and emotional consequences of their treatment. Holistic and personalized assessment of needs becomes increasingly important with age, particularly with comorbidity. Effective rehabilitative care is important to reduce the impact of breast cancer into old age.

Abstract 1829: Predictors of quality of life among Hispanic and non-Hispanic White women: A 15 year follow-up study of long-term breast cancer survivors

Abstract Background: Breast cancer survivors are the largest group of cancer survivors, comprising 23% of the total. While significant predictors of quality of life (QOL) have emerged among independent studies, data is lacking for long-term survivors as well as for differences between Hispanic (H) and Non-Hispanic White (NHW) women. Investigating QOL is important for the evaluation of the consequences of breast cancer beyond the diagnosis and treatment phases. Methods and Materials: Participants from the New Mexico Women's Health Study (NMWHS), population-based case-control investigation (1992-1996) were contacted by telephone 12-15 years after the original interview. QOL was assessed using the MOS SF-36, a generic, multi-purpose, health survey composed of 36 questions that has been utilized and validated to evaluate physical and mental health in many diverse populations. Multivariable linear regression was used to evaluate differences between cases and controls for eight sub-scales and two summary scales adjusting for potential covariates, including stratification by ethnicity for physical and mental health summary scales. Means for scales were log transformed and normalized and compared to the 1998 U.S. general population of females aged 55-64. Results: There was a significant difference between cases and controls for the mental health summary (β=−3.74; p=0.04) but not physical health summary (β=−2.53; p=0.14) scale. Significant predictors for both summary scales included: age, ≥4 co-morbidities, current pain and fatigue, and less education. Social support (p=0.002), case (p=0.02) and ethnicity (p=0.02) were significant predictors of mental health while BMI (p<0.0001) was significant for physical health. Adjustment for time since diagnosis, current marital status, and menopausal status did not alter the results. When stratified by ethnicity, and adjusted for all significant covariates, there was a significant difference in mental health summary between cases and controls for H women (p=0.03). Transformed means for eight subscales and physical health summary were higher for both cases and controls compared to normative data, with the exception of mental health summary for cases. Conclusion: Breast cancer survivors report lower mental health scores on the SF-36 than control women 12 to 15 years after diagnosis and treatment. Hispanic cases, in particular, report lower mental health scores even after adjustment for multiple covariates including co-morbidity, pain and fatigue, education, and social support. This is one of the first studies to detect persistent problems with QOL in long-term breast cancer survivors. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1829. doi:10.1158/1538-7445.AM2011-1829

Myth-Busters: Telling the True Story of Breast Cancer Survivorship

Myth-Busters: Telling the True Story of Breast Cancer Survivorship

Help-seeking intentions for breast-cancer symptoms: a comparison of the self-regulation model and the theory of planned behaviour.

Delays in seeking help for symptoms have been found to be associated with poorer outcome in breast-cancer patients. This study explores symptom perceptions and health beliefs as predictors of intentions to seek medical help in a general female population. The utility of the self-regulation model of illness cognition and the theory of planned behaviour were examined in predicting help-seeking intentions for potential symptoms of breast cancer in a general population sample. A general population sample of 546 women completed a postal questionnaire comprising items examining components of the self-regulation model and the theory of planned behaviour. Help-seeking intention was determined by asking participants to rate the likelihood of visiting their GP for a range of breast symptoms. Hierarchical multiple regression analysis revealed that the cognitive component of the self-regulation model accounted for approximately 22% of the variance in help-seeking intention. Identity (beta = 0.45, p <.001) emerged as a significant predictor of intention to seek help. Inclusion of the components of the theory of planned behaviour accounted for an additional 7% of the variance; the significant predictors were attitude to help-seeking (beta = 0.19, p <.001) and perceived behavioural control (beta = 0.12, p <.01). Intention to seek medical help for a potential breast-cancer symptom may be mediated, partly, by cognitive representations of the identity and consequences of breast cancer and by attitudes towards help-seeking and perceived behavioural control. Although less than one-third of the variance was accounted for, these results have important implications for future research (in terms of identifying which variables should be examined) and for the development of a model of help-seeking behaviour in women with breast-cancer symptoms.