Purpose: Guided by the Self-Regulation Model, this study examined how fear and risk perceptions of breast cancer recurrence impact survivors' interpretation of new symptoms, behaviors to prevent recurrence and health care utilization following treatment.

Methods: Consecutive patients of 5 oncologists at two cancer centers with a history of Stage I-III breast cancer who completed treatment and not had a recurrence were invited to complete a survey during a follow-up oncology appointment (N=111, 73%). The survey assessed fear and risk perception of recurrence, health behaviors to prevent recurrence, health care utilization, and worry and likelihood of contacting a physician in response to hypothetical symptoms.

Results: Patients' mean worry was 6 (SD=8) on a 0-24 scale. 49% of patients reported fear from the loss of the “safety net of treatment.” 62% and 64% of patients would contact the doctor if they experienced unusual fatigue and new breast pain, respectively. Fear of recurrence and intrusive/avoidant thinking about recurrence were positively associated with behavioral changes (e.g., mammograms, herb use) patients made since diagnosis to prevent recurrence (t=2.89, p=.005; t=2.58, p=.011). Both predictors were positively associated with likelihood of contacting a physician in response to new breast pain and unusual fatigue and with worry that each symptom indicates a recurrence (t>2.08, p<.04 for all). Only worry in response to the new breast pain significantly increased with risk perception of recurrence (t=2.27, p=.026). Depressed patients had more (non-mental) health care visits in the past year because of symptoms than non-depressed patients (t=2.32, p=.024). Most of these associations remained after adjusting for disease stage and age.

Conclusions: As predicted by the Self-Regulation model, those who were more worried about recurrence were more likely to interpret new symptoms as a recurrence, engage in preventive health behaviors and utilize health care services in response to new symptoms. These results highlight the importance of interventions to address fears of recurrence among breast cancer patients following treatment to reduce patient distress as well as health care costs and unnecessary, risky tests driven by this distress.