Body image in breast cancer survivors: Age-moderated effects of treatment-induced menopause and fertility concerns

Purpose: Hormone receptor-positive breast cancer survivors undergoing endocrine therapy face significant body image challenges. This study aimed to examine differences in body image between hormone receptor-positive breast cancer survivors receiving endocrine therapy and unaffected, healthy women. Specifically, we investigated whether treatment-induced menopausal symptoms and fertility concerns mediate the relationship between breast cancer survivorship and body image. Additionally, we explored whether age moderates these mediation effects, assessing whether the strength of these indirect relationships varies across different age groups. Methods: 121 hormone receptor-positive breast cancer survivors and 114 healthy women completed a sociodemographic questionnaire, the Body Image Scale (BIS), the Menopausal Rating Scale (MRS), and the Reproductive Concerns Scale (RCS). Breast cancer survivors also completed a medical data questionnaire. Results: Hormone receptor-positive breast cancer survivors reported significantly higher levels of negative body image, menopausal symptoms, and fertility concerns compared to healthy women. Moderated mediation analyses revealed that both menopausal symptoms and fertility concerns mediated the relationship between breast cancer and body image, with age moderating these relationships. The indirect effects were stronger among younger women and diminished with age. The mediating effect through menopausal symptoms was particularly pronounced for somatic and urogenital symptoms. Conclusions: These results highlight the significant role of treatment-induced menopausal symptoms and fertility concerns in shaping body image among young hormone receptor-positive breast cancer survivors. These young women should be provided with targeted information and interventions that will help them cope with treatment-related side effects and maintain positive body image as part of the recovery process.