Post-Treatment Perspectives on Health Literacy and the  Misperception of Breast Cancer Recurrence Risk: A Scoping  Review

Dian Anggraini; Linlin Lindayani; Dewi Marfuah

doi:10.31557/apjcc.2026.11.3.459-466

Authors

Dian Anggraini Department of Medical Surgical Nursing, Faculty of Nursing Science, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, West Java, Indonesia.
Linlin Lindayani Department of Medical Surgical Nursing, Faculty of Nursing Science, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, West Java, Indonesia.
Dewi Marfuah Department of Medical Surgical Nursing, Faculty of Nursing Science, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, West Java, Indonesia.

DOI:

https://doi.org/10.31557/apjcc.2026.11.3.459-466

Keywords:

Breast Neoplasms; Health Literacy; Recurrence; Risk Perception; Fear of Cancer Recurrence; Survivorship

Abstract

Introduction: Many breast cancer survivors continue to experience emotional challenges after completing treatment. Fear of cancer recurrence (FCR) and misperception of recurrence risk, including both overestimation and underestimation, can shape survivors’ well-being and influence how they participate in follow-up care. Health literacy (HL), defined as the ability to find, understand, and use health information, plays an essential role in how survivors interpret health messages and make decisions about their ongoing care. However, the connection between HL and recurrence risk misperception has not been clearly synthesized. This scoping review maps existing patterns and associations, rather than causal relationships, between HL, FCR, and recurrence risk misperception among post-treatment breast cancer survivors.

Materials and Methods: Guided by the Joanna Briggs Institute framework and PRISMA-ScR guidelines, searches were conducted in PubMed, Scopus, CINAHL, ScienceDirect, and grey literature from January 2010 to April 2025. Studies were included if they involved adults in the post-treatment phase and examined HL alongside cognitive or emotional outcomes related to recurrence.

Results: Thirteen studies met the inclusion criteria, most using cross-sectional designs across the United States, Europe, and Asia. Many survivors overestimated their recurrence risk and demonstrated low HL, especially older adults and individuals with lower educational attainment. HL was consistently linked to more accurate risk understanding and, in some studies, mediated the effects of FCR on functional recovery.

Conclusion: HL is a meaningful and modifiable factor that influences how survivors understand and cope with the possibility of cancer returning. Strengthening survivorship communication and developing culturally responsive patient education strategies may help survivors feel more informed, supported, and confident as they navigate life after treatment.