Living with increased risk for breast and ovarian cancer: Do religion and spirituality influence health behavior

Religion and spirituality (R/S) have been shown to influence health behavior in many populations, but little is currently known about their role in the health behavior of women at increased risk for hereditary breast and ovarian cancer (HBOC); the scant data that exists suggests a complex relationship. Given the high stakes of cancer risk-management decisions faced by women with HBOC, and the fact that many people draw on R/S resources in making major life decisions, R/S may be highly relevant in this arena. This study investigated relationships between R/S and cancer screening guideline adherence (mammogram, clinical breast and pelvic exam, breast self-exam), utilization of risk-reducing interventions (prophylactic mastectomy, oophorectomy and chemoprevention) and the use of complementary and alternative medicine (CAM) among 130 women who met criteria for increased HBOC risk. Participants had received genetic counseling at the University of Chicago Cancer Risk Clinic 1-5 years prior to completing a cross-sectional survey assessing pertinent variables; a subset had been offered genetic testing.;Primary regression analyses largely failed to identify anticipated direct or mediated relationships between R/S orientation and health behavior outcomes. Moderation analyses, however, revealed that self-identified religiosity and self-identified spirituality each interacted with cancer risk cues in predicting adherence to guidelines for clinic-based cancer screening and breast self-exam (interaction ps < .05 in all 3 significant models). Specifically, among participants with a heightened risk cue (personal cancer history and/or BRCA1/2 mutation, or higher perceived cancer risk) greater R/S was associated with decreased odds of adherence to screening guidelines, while conversely, among women without these heightened risk cues, greater R/S was associated with increased odds of guideline adherence. Findings suggest that R/S may affect the screening behavior of some women at increased HBOC risk, but that this influence is moderated by cancer risk cues - both perceived and biological. Notably, these risk cues are salient even within this population defined by a common baseline of elevated cancer risk. The consistency of these results provides the strongest evidence to date that R/S may indeed play a role, albeit a complex one, in the health behavior of women at increased risk for HBOC.