UC San Diego

This dissertation's three research papers examine issues relevant to younger breast cancer survivors and their health care providers. Research Paper I is an exploratory, qualitative study to investigate breast cancer survivors' experiences with breastfeeding (N=11). Research Paper II is a nested case-control study to evaluate physical and mental health differences among women who had a child after breast cancer compared to those who did not (N=81). Research Paper III is a cohort study evaluating the association between long-term depressive symptoms and post -diagnosis reproductive concerns (N=131). All three studies include participants diagnosed with early stage breast cancer at age 40 or younger who participated in the Women's Healthy Eating and Living (WHEL) study (N=3088), a multiyear randomized trial of a dietary intervention. Research Paper I includes a purposeful sample of 11 survivors who had a child after treatment ended. We conducted open-ended semi-structured interviews and used cross-case inductive analysis to identify themes. Ten of 11 participants initiated breastfeeding. The main themes were: 1) Cautiously hopeful, 2) Exhausting to rely on one breast, 3) Motivated despite challenges, 4) Support and lack of support, and 5) Encouraging to others. Participants were motivated to breastfeed but faced significant challenges, largely due to a reliance on one lactating breast. Research Paper II is a nested case- control study involving 81 WHEL participants, 27 cases who had a child after cancer and 54 controls who did not (matched on age and stage at diagnosis). This study explores a selection bias indicating that cancer survivors who become pregnant are a self-selected healthier group. After controlling for covariates in a multilevel model, physical health was not different between groups but mental health was marginally higher among cases, meeting a level of clinical significance. Research Paper III is a cohort study involving 131 WHEL participants who participated in a continuation survivorship study. This study investigates whether recalled concerns about reproduction after breast cancer treatment are associated with long-term depressive symptoms, monitored at up to 6 time-points. Multi-level modeling identified higher reproductive concerns as an independent predictor of consistent depressive symptoms after controlling for both social support and physical health.