Abstract
BACKGROUND: Fear of cancer recurrence (FCR) is prevalent among patients with breast cancer, yet those at high risk are not well characterized. AIMS: This study aimed to identify the patient characteristics associated with FCR after diagnosis. METHODS: Between July and September 2023, participants in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort completed the 9-item FCR-Short Form Inventory. A score of 22 or higher indicated clinically significant FCR (csFCR). Logistic and linear regression estimated associations between different risk factors and csFCR and FCR scores, respectively. Missing data were addressed using multiple imputation. RESULTS: Among 1390 stage I-III patients (mean age 63.1 years and 9.1 [mean] years since diagnosis), 262 (18.8%) reported csFCR. In adjusted models, csFCR was associated with having another cancer excluding non-melanoma skin (adjusted odds ratio [aOR], 2.64; 95% CI, 1.66-4.21), greater levels of stress (aOR, 2.40 per 1-SD increment; 95% CI, 1.98-2.91), having a prior recurrence (aOR, 2.26; 95% CI, 1.14-4.47), and having estrogen receptor-positive tumors (aOR, 1.60; 95% CI, 1.06-2.40). Older age at diagnosis (aOR, 0.64 per 10-year increment; 95% CI, 0.56-0.73) was associated with lower odds of csFCR. Similar associations were observed with continuous FCR scores, along with advanced stage at diagnosis associated with higher FCR scores (p-trend = 0.001). CONCLUSIONS: Nearly 1 in 5 breast cancer patients reported csFCR. Key risk factors included younger age at diagnosis, history of recurrence or other malignancies, greater levels of stress, and estrogen receptor-positive breast cancer, which can inform targeted interventions to support survivorship.