Unwanted effects of risk notification for breast cancer regarding intention toward mammography utilization

Objective: This study was conducted to explore the possible influence of risk notification regarding breast cancer on the intention of women to undergo mammography. Methods: This study employed an uncontrolled before–after design. A baseline survey was conducted in a random sample of 1000 women to examine the sociodemographic variables, breast cancer risk factors, and screening‐related variables. All subjects received the findings of a personalized health‐risk appraisal (HRA) following the baseline interview. After 2 months of the baseline survey, a survey was conducted in 855 women to assess whether the intention of undergoing mammography had changed. Thus, the modification in the intention by communicating the individual risk status was assessed. Results: There was an overall increase from baseline to post‐intervention in the number of subjects with the intention of undergoing mammography. Women in the contemplation and action stages who had intention toward mammography utilization at baseline showed decreased intention regarding mammography. After intervention in the form of HRA to promote mammography utilization, it was determined that young age, being married, being in neither the precontemplation nor the relapse stage, and having one or more risk factors of breast cancer were the predictors of intention to undergo mammography. Conclusions: Our findings indicate that communicating the risk status by HRA service can have a negative effect in the promotion of health‐conscious behavior. The selection of the appropriate type of intervention using HRA to promote mammography utilization in the target group will be enhanced by taking into account the risk status of each client. Copyright © 2009 John Wiley & Sons, Ltd.     

Heightened perception of breast cancer risk in young women at risk of familial breast cancer

The objective of this study was to explore the factors that influence perceived personal risk of developing breast cancer (BC) in younger women (<35) who are considering or have undergone bilateral prophylactic mastectomy (BPM). Qualitative interviews guided by interpretative phenomenological analysis were conducted with 46 women who had a strong family history of BC and had either undergone (n?=?26) or were considering (n?=?20) BPM. Participants were recruited from Australia and New Zealand via hospitals, a genetics clinic, a research cohort, a registry and online. Three main themes were identified: information that increases fear of BC and death, underlying anxiety and fear and screening anxiety. A further two themes: relief following surgery and confusion about residual risk following surgery were identified. Younger women (<35) appeared to have heightened and sometimes inaccurate perceptions of their BC risk. They appeared less relieved of anxiety and fear of developing BC by BPM surgery, in comparison to previous research with older women (>40). Those who had undergone BPM seemed more anxious about their risk of developing BC than those who were still considering surgery. This research has important implications for practice, particularly improving communication of accurate risk statistics. Future research should examine why some women interpret information differently and explore the benefits of psychological consultation for very anxious women.     

Misperceptions of ovarian cancer risk in women at increased risk for hereditary ovarian cancer

This study assessed the sociodemographic, medical and psychological predictors of accuracy of perceived risk in women at increased genetic risk for ovarian cancer. Women participating in a large cohort study who were at increased risk of ovarian and fallopian tube cancer, had no personal history of cancer and had ≥1 ovary in situ at cohort enrolment, were eligible. Women completed self-administered questionnaires and attended an interview at enrolment. Of 2,868 women unaffected with cancer at cohort enrolment, 561 were eligible. 335 women (59.8 %) overestimated their ovarian cancer risk, while 215 women (38.4 %) accurately estimated their risk, and 10 (1.8 %) underestimated it. Women who did not know their mutation status were more likely to overestimate their risk (OR 1.74, 95 % CI 1.10, 2.77, p = 0.018), as were those with higher cancer-specific anxiety (OR 1.05, 95 % CI 1.02, 1.08, p < 0.001) and/or a mother who had been diagnosed with ovarian cancer (OR 1.98, 95 % CI 1.23, 3.18, p = 0.005). Amongst the group of women who did not know their mutation status, 63.3 % overestimated their risk and the mean perceived lifetime risk of developing ovarian cancer was 42.1 %, compared to a mean objective risk of 6.4 %. A large number of women at increased risk for ovarian cancer overestimate their risk. This is of concern especially in women who are at moderately increased risk only; for this sub-group of women, interventions are needed to reduce potentially unnecessary psychological distress and minimise engagement in unnecessary surgery or screening.     

Psychological distress in women at risk of hereditary breast/ovarian or HNPCC cancers in the absence of demonstrated mutations

Aim: To examine psychological distress in women at risk of familial breast–ovarian cancer (FBOC) or hereditary non-polyposis colorectal cancer (HNPCC) with absence of demonstrated mutations in the family (unknown mutation).Materials and methods: Two-hundred and fifty three consecutive women at risk of FBOC and 77 at risk of HNPCC and with no present or past history of cancer. They were aware of their risk and had received genetic counseling. Comparisons were made between these two groups, normal controls, and women who were identified to be BRCA1 mutation carriers. The questionnaires Beck Hopelessness Scale (BHS), General Health Questionnaire (GHQ-28), Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale (IES) were employed to assess psychological distress.Results: No significant differences concerning psychological distress were observed between women with FBOC and women with HNPCC. Compared to mutation carriers for BRCA1, the level of anxiety and depression was significantly higher in the FBOC group with absence of demonstrated mutation. Compared to normal controls, the level of anxiety was higher, while the level of depression was lower in the groups with unknown mutation.Conclusions: Women in the absence of demonstrated mutations have higher anxiety and depression levels than women with known mutation-carrier status. Access to genetic testing may be of psychologically benefit to women at risk for FBOC or HNPCC.     

Adjustment to perceived ovarian cancer risk

Eighty-three women who perceived themselves to be at risk for ovarian cancer completed a battery of surveys. In addition to demographics, subjects were asked to complete the Brief Symptom Inventory, Multidimensional Health Locus of Control, Death Anxiety Scale, Taylor Anxiety Scale, Index of Sexual Satisfaction, Impact of Event Scale, and the Marlowe-Crowne Social Desirability Scale. Overall, the respondents were more similar to normal controls than to psychiatric outpatients. A correlation was drawn between higher levels of education and lower scores on the Brief Symptom Inventory, which measures characteristics such as somatization, obsessive compulsive behaviors, interpersonal sensitivity, and anxiety. However, those who had the highest scores on the Death Anxiety Scale were less likely to comply with the recommendation for a physical/gynecological examination. Patients who were most influenced by an external locus of control or 'powerful other' were more compliant with their physicians' recommendations for testing and examination. It is the authors' belief that individualized educational efforts and the presence of a solid support system may increase women's adherence to the recommended health care practices.     

Demographic and psychosocial factors associated with perceived risk for colorectal cancer.

OBJECTIVES: The objective of this study was to investigate demographic and psychosocial predictors of perceptions of risk for colorectal cancer (CRC) in a population-based sample. METHODS: The study was a cross-sectional survey of 18,447 men and women aged 55-64 years. A mailed questionnaire assessed perceived comparative risk for CRC along with demographic characteristics (age, gender, ethnicity, marital status, and socioeconomic status), health-related factors (family history, subjective health and bowel symptoms, and health behaviors), and emotional state (anxiety). RESULTS: Being male and older were associated with lower perceived risk. Having a family history of CRC, poorer subjective health, more symptoms, and higher levels of anxiety were all associated with increased perceived risk of CRC. Smokers and nonexercisers perceived their risk as higher. CONCLUSIONS: Misperceptions surrounding the effects of age and gender on CRC risk, as well as the genetic link and pathogenesis of CRC, need to be addressed in risk communications.     

A randomized trial of specialist genetic assessment: psychological impact on women at different levels of familial breast cancer risk

The aim was to compare the psychological impact of a multidisciplinary specialist genetics service with surgical provision in women at high risk and those at lower risk of familial breast cancer. Women (n=735) were randomized to a surgical consultation with (trial group) or without (control group) specialist genetic risk assessment and the possible offer of presymptomatic genetic testing. Participants completed questionnaires before and immediately after the consultation to assess anxiety, cancer worry, perceived risk, interest in genetic testing and satisfaction. Responses of subgroups of women stratified by clinicians as low, moderate, or high risk were analyzed. There were no significant main effects of study intervention on any outcome variable. Regardless of risk information, there was a statistically significant reduction in state anxiety (P<0.001). Reductions in cancer worry and perceived risk were significant for women at low or moderate risk (P<0.001) but not those at high risk, and satisfaction was significantly lower in the high risk group (P<0.001). In high risk women who received specialist genetic input, there was a marginally significant trend towards increased perceived risk. The effect of risk information on interest in genetic testing was not significant. Breast care specialists other than geneticists might provide assessments of breast cancer risk, reassuring women at reduced risk and targeting those at high risk for specialist genetic counselling and testing services. These findings are discussed in relation to the existing UK Calman-Hine model of service delivery in cancer genetics. DOI: 10.1038/sj/bjc/6600051 www.bjcancer.comCopyright 2002 The Cancer Research Campaign     

Psychosocial factors and uptake of risk-reducing salpingo-oophorectomy in women at high risk for ovarian cancer

Bilateral risk-reducing salpingo-oophorectomy (RRSO) has been shown to significantly reduce the risk of ovarian cancer. This study assessed factors predicting uptake of RRSO. Women participating in a large multiple-case breast cancer family cohort study who were at increased risk for ovarian and fallopian tube cancer (i.e. BRCA1 or BRCA2 mutation carrier or family history including at least one first- or second-degree relative with ovarian or fallopian tube cancer), with no personal history of cancer and with at least one ovary in situ at cohort enrolment, were eligible for this study. Women who knew they did not carry the BRCA1 or BRCA2 mutation segregating in their family (true negatives) were excluded. Sociodemographic, biological and psychosocial factors, including cancer-specific anxiety, perceived ovarian cancer risk, optimism and social support, were assessed using self-administered questionnaires and interviews at cohort enrolment. RRSO uptake was self-reported every three years during systematic follow-up. Of 2,859 women, 571 were eligible. Mean age was 43.3 years; 62 women (10.9 %) had RRSO a median of two years after cohort entry. Factors predicting RRSO were: being parous (OR 3.3, p = 0.015); knowing one’s mutation positive status (OR 2.9, p < 0.001) and having a mother and/or sister who died from ovarian cancer (OR 2.5, p = 0.013). Psychological variables measured at cohort entry were not associated with RRSO. These results suggest that women at high risk for ovarian cancer make decisions about RRSO based on risk and individual socio-demographic characteristics, rather than in response to psychological factors such as anxiety.     

Psychological aspects of ovarian cancer.

Ovarian cancer presents a range of physical and psychological symptoms during stages of diagnosis, treatment, and survival. Women at risk for ovarian cancer who attend screening programs are vulnerable to high levels of depression and anxiety, particularly young women with poor social support. Multiple physiological stressors of surgical menopause, steroid therapy, and pain present during active treatment that place women at high risk of depression and anxiety during this time. Symptoms of anxiety and depression are also prevalent immediately after chemotherapy and during palliative care. Screening for psychological distress may be useful to identify women who will benefit from psychological counseling. They should be referred to a mental health professional affiliated with the hospital at which they are receiving oncology services. Brief group or individual supportive psychotherapies are effective in relieving psychological distress. Face-to-face psychological intervention should be tailored to the patient's degree of physical mobility. Pain, discomfort, and severe mood symptoms should be addressed pharmacologically, when possible, by a psychiatric consultant knowledgeable in oncology psychiatry. Survivors experience chronic fear of recurrence, sexual dysfunction, and identity disturbance. Reports that ovarian cancer can result in positive life changes, such as closer interpersonal relationships, are encouraging and may provide hope to patients who become despairing about the future.     

Then and now: quality of life of young breast cancer survivors

BACKGROUND: Women under age 50, a quarter of all cases of breast cancer, are especially vulnerable to physical and psychosocial late effects of their treatment due to having more aggressive treatment and their relative youth. METHODS: In person interviews were conducted with the population-based sample: 185 women who were under 50 at diagnosis and were cancer-free 5 years later. Quality of life in the physical, psychological, social, and spiritual domains was assessed and compared with results obtained a few months after diagnosis. RESULTS: Five years after diagnosis, 92% rated their health as good or excellent, and only 10% said their health had been getting worse. Between baseline and 5 years, there were significant improvements in surgical symptoms, body image, worry about the future, patient-physician communication, intrusiveness of treatment, and all of the SF-36 measures except for general health. There were significant decreases in emotional support and the size of one's social network. More women were now menopausal (75% due to treatment) and there were fewer children at home. There were no significant changes in employment status, marital/partner status, sexual activity, sexual problems, self-esteem, and attendance at religious services or frequency of prayer. In multivariate models, a greater increase in physical quality of life was associated with reporting fewer chronic conditions, being employed, having been treated by chemotherapy and fewer had no children under age 18 living at home. A greater increase in mental quality of life was associated with fewer chronic conditions and a smaller decrease in emotional support. CONCLUSIONS: Five years after diagnosis, young breast cancer survivors who remained cancer-free enjoyed good health and improved quality of life. Nonetheless, physical, social, and psychological concerns must be addressed so that young breast cancer survivors will continue to be resilient as they age.     

The evolution of worry after breast cancer risk assessment: 6‐year follow‐up of the TRACE study cohort

Objectives: There is little evidence regarding the long‐term psychological implications of breast cancer risk assessment for women at moderate genetic risk. A follow‐up study of a trial cohort was conducted to evaluate psychological outcomes and their predictors at 6‐year follow‐up. A further aim was to examine threshold scores for high cancer worry. Methods: Questionnaires were sent to 384 women assessed as moderate risk during a UK trial of genetic assessment (TRACE). Measures included cancer worry, perceived risk, health behaviours, general anxiety, psychological morbidity, optimism, and background variables assessed during TRACE and at 6‐year follow‐up. Results: Reductions from baseline cancer worry and breast self‐examination (BrSE) frequency were maintained 6 years after risk assessment, with relatively consistent levels over short‐ and long‐term follow‐up. Provision of risk information led to short‐term reductions in perceived risk. During the 6‐year period, 43% of women reported having made lifestyle changes and 27% had requested a mammogram. Baseline and post‐risk cancer worry were the only significant predictors of long‐term cancer worry. Greater worry at baseline predicted more frequent BrSE and higher perceived risk, but not lifestyle change or mammogram requests, at 6 years. Eighteen percent of women reported cancer worry above a threshold of 12.5 at long‐term follow‐up, compared with 30% at baseline. Conclusions: Overall reductions in cancer worry following moderate risk assessment were maintained in the long term. However, women at risk of sustained high cancer worry should be identified at an early stage in the risk assessment process for more intensive psycho‐educational intervention. Copyright © 2010 John Wiley & Sons, Ltd.     

Pessimism as a predictor of emotional morbidity one year following breast cancer surgery

The prevalence of and predictive factors for emotional morbidity (measured by the Hospital Anxiety and Depression Scale (HAD)) one year following surgery, with special focus on dispositional optimism/pessimism (measured by the Life Orientation Test (LOT-R), was examined in 165 women, newly diagnosed with breast cancer. Patients characteristics, appraisal of cancer diagnosis, beliefs about treatment efficacy, treatment decision-making participation, coping and emotional morbidity was assessed by self-rating questionnaires.Prevalence of anxiety and depression cases at time of diagnosis was 34 and 12%, respectively, and 26 and 9% after one year. Prevalence of emotional morbidity was significantly enlarged among pessimists at all assessments.Pessimism was the strongest predictor for anxiety (OR: 0.86 C.I. 95% 0.77 - 0.95) and depression (OR: 0.83, C.I. 95% 0.73 - 0.95) one year following breast cancer surgery. Optimists and pessimists differed not only in regard to coping styles, but also in regards to predictors of emotional morbidity. Optimists experiencing anxiety at time of breast cancer diagnosis had about six times higher risk of experiencing anxiety after one year, compared to optimists without preoperative anxiety. For pessimists, the more pessimistic one was about one's overall future the higher risk for developing anxiety following one year of breast cancer surgery. Pessimists, who endorse helpless/hopeless coping style when receiving a diagnosis of breast cancer, had three times greater risk for experiencing depression one year after breast cancer surgery, than pessimists who did not. Health care professionals should therefore provide intervention for pessimists, as well as for patients with high anxiety scores at time of diagnosis.     

Breast cancer risk in relation to abortion: Results from the EPIC study

The role of spontaneous and induced abortion on breast cancer risk is examined among 267,361 women recruited into the European Prospective Investigation into Cancer and nutrition between 1992 and 2000. The data were collected from 20 centers, across 9 countries, and included information on a total of 4,805 women with breast cancer, of whom 1,657 reported having ever had any type of abortion. Overall, the relative risk of breast cancer in women who reported ever having had a spontaneous abortion was not significantly elevated when compared with women who reported never having had such an abortion (RR = 1.07, 95% CI = 0.99-1.14). However, there was some evidence of a slight increase in the risk of breast cancer among women who reported having had 2 or more spontaneous abortions (1.20, 1.07-1.35). The relative risk of breast cancer among women who reported ever having had an induced abortion when compared to women who reported never having had an induced abortion was 0.95 (0.87-1.03). Overall, the findings provide further unbiased evidence of the lack of an adverse effect of induced abortion on breast cancer risk.     

Decision-making about tamoxifen in women at high risk for breast cancer: clinical and psychological factors.

PURPOSE: To explore the health-related and psychological factors that influence decision making about tamoxifen (Nolvadex; AstraZeneca, Waltham, MA) chemoprevention in women at increased risk for developing breast cancer. METHODS: This study involves the assessment of 129 women eligible to take tamoxifen following cancer-risk counseling. Treatment decision and decision satisfaction were measured at 2 and 4 months following counseling. Health-related factors included physician recommendation, personal and family-related health history, and concern about side effects. Psychological factors included breast cancer-related anxiety, risk perception, and depression. RESULTS: At 2 months' follow-up, 44% of participants declined tamoxifen treatment. This number increased to 49% at 4 months. Personal and family health history were not related to the decision, but history of abnormal biopsy did predict tamoxifen use. Physician recommendation was highly correlated with treatment decision. Concern about side effects was related to the decision to decline treatment. Breast cancer-related anxiety and heightened risk perception were associated with the decision to take tamoxifen. However, anxiety and psychological distress were also negatively related to treatment satisfaction. CONCLUSION: Decision-making about tamoxifen is complex, and many eligible women decline treatment or remain undecided. Findings call for further educational follow-up with high-risk women after they undergo initial counseling. Factors related to misperceptions of risk and side effects, as well as psychological distress, may be particularly important targets for intervention.     

Influence of health insurance coverage on breast,cervical, and colorectal cancer screening in rural primary care settings

BACKGROUND:

The current study was performed to determine, in rural settings, the relation between the type and status of insurance coverage and being up‐to‐date for breast, cervical, and colorectal cancer screening.

METHODS:

Four primary care practices in 2 rural Oregon communities participated. Medical chart reviews that were conducted between October 2008 and August 2009 assessed insurance coverage and up‐to‐date status for breast, cervical, and colorectal cancer screening. Inclusion criteria involved having at least 1 health care visit within the past 5 years and being aged ≥ 55 years.

RESULTS:

The majority of patients were women aged 55 years to 70 years, employed or retired, and who had private health insurance and an average of 2.5 comorbid conditions. The overall percentage of eligible women who were up‐to‐date for cervical cancer screening was 30%; approximately 27% of women were up‐to‐date for clinical breast examination, 37% were up‐to‐date for mammography, and 19% were up‐to‐date for both mammography and clinical breast examination. Approximately 38% of men and 35% of women were up‐to‐date for colorectal cancer screening using any test at appropriate screening intervals. In general, having any insurance versus being uninsured was associated with undergoing cancer screening. For each type of screening, patients who had at least 1 health maintenance visit were significantly more likely to be up‐to‐date compared with those with no health maintenance visits. A significant interaction was found between having health maintenance visits, having any health insurance, and being up‐to‐date for cancer screening tests.

CONCLUSIONS:

Overall, the percentage of patients who were up‐to‐date for any cancer screening, especially cervical cancer screening, was found to be very low in rural Oregon. Patients with some form of health insurance were more likely to have had a health maintenance visit within the previous 2 years and to be up‐to‐date for breast, cervical, and/or colorectal cancer screening. Cancer 2012. © 2012 American Cancer Society.     

Determination of The Anxiety Level of Women Who Presentfor Mammography

Objective: This paper was to examine the role of anxiety in mammography screening. Breast cancerscreening with mammography has been shown to be effective for preventing breast cancer death. Howevermammography screening can be harmful to women. One of the major problems is anxiety or lack of peace ofmind in mammography screening. Methodology: This study was conducted between November 3, 2007, andDecember 30, 2007, in Ordu Maternity and Childbirth Hospital. 93 women participated in the study. A 23-item questionnaire and the 20-item State Anxiety Inventory, developed by Spielberger et al. were completedby the participants. All numerical values were given as average ± standard deviation; p<0.05 was accepted forlevel of significance. Results: The average age of the participants was 47.83±7.50, the average age at marriagewas 20.03±4.18, the average birth number 2.91±1.21, and the average age at menopause was 46.10±4.70. Theaverage anxiety level was found to be 46.20±4.9. Significant differences (p<0.05) were found between educationlevel, age at marriage, status of doing breast self examination, status of having a mammography for a breastrelatedcomplaint, and the number of mammograms done. Conclusion: It was determined that women who hadmammography had a moderate level of anxiety.     

Genetic counselling for cancer and risk perception

The main aim was to investigate risk perception and psychological distress in individuals attending genetic counselling. A consecutive series of 86 individuals with a diagnosis and/or family history of breast, ovarian or colorectal cancer was included. Risk assessments were performed before and immediately after genetic counselling and at a one-year follow-up. Psychological distress was assessed 1 week before, and 6 weeks, 6 months and 1 year after genetic counselling. The number of individuals who correctly-estimated the general risk in the population increased significantly from 35%, before to 82% after counselling (p < 0.001). One year later, data on general risk estimates showed a significant reduction of the number of correct estimations to 51%, compared with directly after the counselling (p < 0.005). In total, 54% estimated their own lifetime risk correctly after the counselling, compared with 17% before (p < 0.001) (those with a cancer diagnosis estimated the risk of their children developing cancer). One year later, the number of correct estimations had dropped to 28%. Before the counselling, the majority of the participants overestimated both the general risk and their own/children's risk. The participants experienced moderate levels of psychological distress before the counselling and a decrease of anxiety afterwards (p < 0.02). However, half of the participants reported moderate or high distress. There were no differences in psychological distress between those who estimated their risk/ children's risk as low, moderate or high or between those who over-, under- or correctly estimated their own/children's risk. Further investigations are needed to develop and adjust the risk information provided to the individual in order to avoid misunderstanding, especially as this information is going to be revealed to family members Counselling support should be offered to those individuals who experience psychological distress.     

Physical exercise reduces risk of breast cancer in Japanese women

To evaluate the effects of physical exercise on breast cancer risk, a large-scale case-referent study of 2376 incident breast cancer cases and 18 977 non-cancer referents was conducted using data from the hospital-based epidemiologic research program at Aichi Cancer Center (HERPACC). To adjust appropriately for possible confounders, we examined the effects within subgroups of the study population. The multivariable-adjusted odds ratio (OR) was 0.81 (95% confidence interval (CI): 0.69–0.94) for twice a week or more regular exercise. We observed a decreased risk of breast cancer for women who regularly exercised for health twice a week or more, irrespective of menopausal status, and were able to detect greater risk reductions within particular subgroups, including women who were parous, without a family history or non-drinkers. Among premenopausal women, a particularly strong protective effect of physical exercise was observed (OR=0.57, 95%CI: 0.28–1.15) for those women whose body mass index (BMI) was high (BMI≥25). In contrast, risk reduction was found (OR=0.71, 95%CI: 0.50–1.01) among postmenopausal women whose BMI was medium (BMI: 22–25). Stratification of history of stomach cancer screening to adjust modifying effects of healthy consciousness allows a more precise assessment of the protective effect of exercise twice a week or more, independent of stomach cancer screening history. This study provides evidence that physical exercise, especially exercise twice a week or more, reduces the risk of breast cancer among Japanese women. (Cancer Sci 2003; 94: 193–199)     

Anxiety and depression in Iranian breast cancer patients before and after diagnosis

A prospective study was conducted to measure anxiety and depression in Iranian breast cancer patients before and after diagnosis using the Hospital Anxiety and Depression Scale (HADS). The HADS was administered at two points in time: before diagnosis and 3 months after. In all, 168 breast cancer patients were interviewed. While 48% of patients had severe symptoms of anxiety at both baseline and follow-up, more than 60% of patients had no symptoms of depressive illness at pre-and post-diagnosis assessments. Comparing anxiety and depression before diagnosis and after 3 months, there were no significant differences between patients' scores on anxiety (P = 0.42) and depression (P = 0.98) subscales. The results showed that patients with advanced disease and a lower performance status were more anxious and experienced more depression. The study findings suggest that severe symptoms of anxiety are the most frequent symptoms in Iranian breast cancer patients. It seems that during the process of diagnosis and 3 months after psychological morbidity persists in patients who suffer from breast cancer.