Supportive Care in Cancer

, Volume 20, Issue 11, pp 2651–2659 | Cite as

Fear of cancer recurrence in young women with a history of early-stage breast cancer: a cross-sectional study of prevalence and association with health behaviours

  • B. Thewes
  • P. Butow
  • M. L. Bell
  • J. Beith
  • R. Stuart-Harris
  • M. Grossi
  • A. Capp
  • D. Dalley
  • the FCR Study Advisory Committee
Original Article



Fear of cancer recurrence (FCR) is common and associated with younger age. This study aimed to explore the prevalence and correlates of FCR amongst younger survivors of early breast cancer.


A total of 218 women aged 18–45 were diagnosed with stage 0–2 breast cancer at least 1 year earlier.


The participants completed a web-based survey including a validated measure of FCR and items exploring medical surveillance practices and health care use.


A total of 70% of participants reported clinical levels of FCR. Higher FCR was associated with higher frequency of unscheduled visits to the GP, higher frequency of breast self-examination and other forms of self-examination for cancer, not having mammograms or ultrasounds or other forms of cancer screening in the past year, more complementary therapy use and the use of counselling and support groups.


Young women with breast cancer are particularly vulnerable to FCR. The present study provides preliminary evidence that FCR is associated with higher health costs and lower surveillance rates which may compromise health outcomes. Routine screening for FCR in follow-up care is recommended.


Fear of recurrence Cancer Oncology Health behaviours Health service use 



B. Thewes was supported by a National Breast Cancer Post-doctoral Research Fellowship. P. Butow was supported by a NH&MRC Research Fellowship Award. The authors wish to thank the women who participated and acknowledge the assistance of Breast Cancer Network Australia and the Young Breast Cancer Action Group of NSW who assisted with the recruitment of participants for this study. The study sponsors had no role in the design, collection, analysis and interpretation of data, in the writing of the manuscript and in the decision to submit the manuscript for publication.

Conflicts of interest

The authors have no financial and personal relationships with other people or organisations that could bias their involvement in this study.


  1. 1.
    Saphner T, Tormey D, Gray R (1996) Annual hazard rates of recurrence for breast cancer after primary therapy. J Clin Oncol 14(10):2738–2746PubMedGoogle Scholar
  2. 2.
    Vickberg SMJ (2003) The Concerns About Recurrence Scale (CARS): a systematic measure of women’s fears about the possibility of breast cancer reccurrence. Ann Behav Med 25(1):16–24PubMedCrossRefGoogle Scholar
  3. 3.
    Lee-Jones C, Humphries G, Dixon R, Hatcher M (1997) Fear of cancer recurrence; a literature review and proposed cognitive formulation to explain the exacerbation of fears. Psycho-Oncology 6:95–105PubMedCrossRefGoogle Scholar
  4. 4.
    Simard S, Savard J (2009) Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer 17(3):241–251PubMedCrossRefGoogle Scholar
  5. 5.
    Baker F, Denniston M, Smith T, West M (2005) Adult cancer survivors: how are they faring? Cancer 104(11 Suppl):2565–2576PubMedCrossRefGoogle Scholar
  6. 6.
    Armes J, Crowe M, Colbourne L, Morgan H, Murrells T, Oakley C, Palmer N, Ream E, Young A, Richardson A (2009) Patients’ supportive care needs beyond the end of cancer treatment: a prospective, longitudinal survey. J Clin Oncol 27(36):6172–6179PubMedCrossRefGoogle Scholar
  7. 7.
    Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Wain G (2007) Breast cancer survivors’ supportive care needs 2–10 years after diagnosis. Support Care Cancer 15(5):515–523, Epub 2006 Nov 2021PubMedCrossRefGoogle Scholar
  8. 8.
    Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P, Group at SCR (2000) The unmet supportive care needs of patients with cancer. Cancer 88(1):226–238PubMedCrossRefGoogle Scholar
  9. 9.
    Simard S, Savard J (2008) Screening and psychiatric comorbidity of clinical fear of cancer recurrence. Paper presented at the 4th Canadian Breast Cancer Research Alliance Reasons for Hope Scientific Conference, Vancouver, CanadaGoogle Scholar
  10. 10.
    Glynne-Jones R, Chait I, Thomas F (1997) When and how to discharge cancer survivors in long term remission from follow-up: the effectiveness of a contract. Clin Oncol 9(1):25–29CrossRefGoogle Scholar
  11. 11.
    Hart S, Latini D, Cowan J, Carroll P, CaPSURE Investigators (2008) Fear of recurrence, treatment satisfaction, and quality of life after radical prostatectomy for prostate cancer. Support Cancer Care 16:161–169CrossRefGoogle Scholar
  12. 12.
    Burstein H, Gelber S, Guadognoli E, Weeks J (1999) The use of alternative medicine by women with early-stage breast cancer. N Engl J Med 340(22):1733–1739PubMedCrossRefGoogle Scholar
  13. 13.
    Curran D, van Dongen JP, Aaronson NK, Kiebert G, Fentiman IS, Mignolet F, Bartelink H (1998) Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG). Eur J Cancer 34(3):307–314PubMedCrossRefGoogle Scholar
  14. 14.
    Hartl K, Janni W, Kastner R, Sommer H, Strobl B, Rack B, Stauber M (2003) Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients. Ann Oncol 14(7):1064–1071PubMedCrossRefGoogle Scholar
  15. 15.
    Mast ME (1998) Survivors of breast cancer: illness uncertainty, positive reappraisal, and emotional distress. Oncol Nurs Forum 25(3):555–562PubMedGoogle Scholar
  16. 16.
    Stanton AL, Danoff-Burg S, Huggins ME (2002) The first year after breast cancer diagnosis: hope and coping strategies as predictors of adjustment. Psycho-Oncology 11(2):93–102PubMedCrossRefGoogle Scholar
  17. 17.
    Thewes B, Butow P, Girgis A, Pendlebury P (2004) The psychosocial needs of breast cancer survivors; a qualitative study of the shared and unique needs of younger versus older breast cancer survivors. Psycho-Oncology 13(3):177–189PubMedCrossRefGoogle Scholar
  18. 18.
    Walker BL (1997) Adjustment of husbands and wives to breast cancer. Cancer Pract 5(2):92–98PubMedGoogle Scholar
  19. 19.
    Khatcheressian J, Wolff A, Smith T, Grunfeld E, Muss HV, Vogel V, Halberg F, Somerfield M, Davidson N (2006) American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol 24(31):5091–5097PubMedCrossRefGoogle Scholar
  20. 20.
    Oh B, Butow P, Mullan B, Clarke S, Tattersall MHN, Boyer M, Beale P, Vardy J, Pavlakis NLL (2010) Patient–doctor communication: the use of complementary and alternative medicine by adult patients with cancer. J Soc Integr Oncol 8(2):56–64PubMedGoogle Scholar
  21. 21.
    Thewes B, Butow P, Zachariae R, Christensen S, Simard S, Gotay C (2011) Fear of cancer recurrence: a systematic literature review of self-report measures. Psycho-Oncology. doi: 10.1002/pon.2070
  22. 22.
    Warwick HMC, Salkovskis PM (1990) Hypochondriasis. Behav Res Ther 28(2):105–117PubMedCrossRefGoogle Scholar
  23. 23.
    Partridge AH, Gelber S, Peppercorn J, Sampson E, Knudsen K, Laufer M, Rosenberg R, Przypyszny M, Rein A, Winer EP (2004) Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol 22(20):4174–4183PubMedCrossRefGoogle Scholar
  24. 24.
    Humphris GM, Ozackinci G (2008) The AFTER intervention: a structured psychological approach to reduce fears of recurrence in patients with head and neck cancer. Br J Heal Psychol 13(2):223–230CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • B. Thewes
    • 1
  • P. Butow
    • 1
  • M. L. Bell
    • 2
  • J. Beith
    • 3
  • R. Stuart-Harris
    • 4
  • M. Grossi
    • 5
  • A. Capp
    • 6
  • D. Dalley
    • 7
  • the FCR Study Advisory Committee
  1. 1.Centre for Medical Psychology and Evidence-Based Decision Making, School of PsychologyUniversity of SydneySydneyAustralia
  2. 2.Psycho-Oncology Cooperative Research Group (PoCOG), School of PsychologyUniversity of SydneySydneyAustralia
  3. 3.Department of Medical Oncology, Sydney Cancer CentreRoyal Prince Alfred HospitalSydneyAustralia
  4. 4.Medical Oncology DepartmentThe Canberra HospitalCanberraAustralia
  5. 5.Peter MacCallum Cancer CentreMelbourneAustralia
  6. 6.Department of Radiation OncologyCalvary MaterNewcastleAustralia
  7. 7.Department of Medical OncologySt Vincent’s HospitalSydneyAustralia

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