Psychological impact of recall on women with BRCA mutations undergoing MRI surveillance

Objective

The addition of magnetic resonance imaging (MRI) to mammography for surveillance of women with BRCA mutations significantly increases sensitivity but lowers specificity. This study aimed to examine whether MRI surveillance, and particularly recall, is associated with increased anxiety, depression, or breast cancer worry/distress.

Methods

Women with BRCA mutations in an MRI surveillance study were invited to complete: Hospital Anxiety and Depression Scale (HADS), Lerman’s Breast Cancer Worry Scale, Breast Cancer Worry Interference Scale, and a quality of life rating at 3 time points: 1–2 weeks before (T1), 4–6 weeks after (T2) and 6 months after their annual surveillance (T3). Repeated measures analyses were performed over the 3 time points for recalled and non-recalled women.

Results

55 women (30 BRCA1, 25 BRCA2) completed study instruments at T1 and T2, and 48 at T3. Eighteen women (32%) were recalled for additional imaging. At T1, 27 women (49%) were above HADS threshold for “possible cases” for anxiety (score ≥8). Recalled (but not non-recalled) women had a significant increase of HADS anxiety at T2 which dropped to below baseline by T3. No group differences were observed in terms of change over time in other quantitative psychological measures.

Conclusions

While breast MRI surveillance did not have a detrimental psychological impact on women with a BRCA1 or BRCA2 mutation, recalling these very high-risk women for further imaging after a false positive MRI scan temporarily increased their global anxiety.     

The measurement of psychological distress in men being investigated for the presence of prostate cancer

High levels (>50%) of anxiety are reported in patients undergoing screening for prostate cancer, which may affect health-related quality of life. We aimed to determine the level and prevalence of anxiety and depression and to identify those aspects of the diagnostic pathway that induce the most stress in men being investigated for prostate cancer. A total of 159 prostate-specific antigen-unscreened men undergoing a transrectal ultrasound-guided biopsy of the prostate (TRUS-B) completed two questionnaires, prior to their biopsy and before receiving results, containing the Hospital Anxiety and Depression Scale (HADS) and a 10-point Visual Analogue Scale (VAS). Median scores and prevalence of anxiety (4-5, 4-7%) and depression (1-2, 1.4%) respectively were low for both questionnaires. Waiting for biopsy results received the highest median VAS score (6) and was the most stressful event in 65% of men. There is a low incidence of clinically significant anxiety and depression in men being investigated for prostate cancer but questionnaires such as HADS identify patients with psychological distress who may benefit from early counselling. Uncertainty about the future while awaiting biopsy results after TRUS-B seems to be the most stressful event in patients' lives and minimizing this wait should help optimize patient care.     

Breast cancer risk,worry, and anxiety: Effect on patient perceptions of false-positive screening results

ObjectiveThe impact of mammography screening recall on quality-of-life (QOL) has been studied in women at average risk for breast cancer, but it is unknown whether these effects differ by breast cancer risk level. We used a vignette-based survey to evaluate how women across the spectrum of breast cancer risk perceive the experience of screening recall.MethodsWomen participating in mammography or breast MRI screening were recruited to complete a vignette-based survey. Using a numerical rating scale (0–100), women rated QOL for hypothetical scenarios of screening recall, both before and after benign results were known. Lifetime breast cancer risk was calculated using Gail and BRCAPRO risk models. Risk perception, trait anxiety, and breast cancer worry were assessed using validated instruments.ResultsThe final study cohort included 162 women at low (n = 43, 26%), intermediate (n = 66, 41%), and high-risk (n = 53, 33%). Actual breast cancer risk was not a predictor of QOL for any of the presented scenarios. Across all risk levels, QOL ratings were significantly lower for the period during diagnostic uncertainty compared to after benign results were known (p < 0.05). In multivariable regression analyses, breast cancer worry was a significant predictor of decreased QoL for all screening scenarios while awaiting results, including scenarios with non-invasive imaging alone or with biopsy. High trait anxiety and family history predicted lower QOL scores after receipt of benign test results (p < 0.05).ConclusionsWomen with high trait anxiety and family history may particularly benefit from discussions about the risk of recall when choosing a screening regimen.     

Measuring the psychosocial impact of population-based prostate-specific antigen testing for prostate cancer in the UK

OBJECTIVE: To evaluate the psychosocial impact of participation in a population-based prostate-specific antigen (PSA) testing programme, akin to screening, and to explore the relationship between urinary symptoms reported before PSA testing and the response to the subsequent PSA result. PATIENTS AND METHODS: This prospective questionnaire study was nested within the case-finding component of the ProtecT (prostate testing for cancer and treatment) feasibility study (ISRCTN20141297). Men aged 50-69 years from 18 general practices in three cities in the UK completed the Hospital Anxiety and Depression Scale (HADS), the Short Form-12 (SF-12) Health Survey, and the International Continence Society 'male' (ICSmale) questionnaires before giving consent for a PSA test in a community clinic (baseline). Men with an 'abnormal' PSA result returned for further investigation (including biopsy) and repeated these questionnaires before biopsy. RESULTS: At baseline, study participants had similar levels of anxiety and depression to the general male population. There was no increase in the HADS scores, or reduction in the SF-12 mental health component summary score, on attendance at the biopsy clinic after receiving an 'abnormal' PSA result. Urinary symptoms were associated with levels of anxiety and depression before receiving a PSA result (baseline), but were not associated with anxiety and depression at biopsy independently of baseline scores. Therefore changes in anxiety or depression at biopsy did not appear to differ between those with and without urinary symptoms. CONCLUSIONS: This study confirms the findings of other studies that the deleterious effects of receiving an abnormal PSA result during population screening are not identified by generic health-status questionnaires. Comparisons with outcomes of studies measuring cancer-specific distress and using qualitative research methods raise the question of whether a prostate cancer screening-specific instrument is required. However, a standardized measure of anxiety identified differences at baseline between those who did and did not report urinary symptoms. These findings suggest that it might be advisable to better inform men undergoing PSA testing about the uncertain relationship between urinary symptoms and prostate cancer, to minimize baseline levels of psychological distress.     

Psychological distress in Japanese men with localized prostate cancer

OBJECTIVE: To investigate: (i) the level of psychological distress; and (ii) the relationships between the level of psychological distress and general or disease-specific HRQOL of Japanese men with localized prostate cancer following surgery or radiotherapy. PATIENTS AND METHODS: The study was a retrospective cross-sectional survey of 253 men with localized prostate cancer treated with radical prostatectomy and 87 with external beam radiotherapy were collected. The measures used four questionnaires including: (i) the Medical Outcomes Study 36-Item Health Survey; (ii) The University of California, Los Angeles Prostate Cancer Index; (iii) International Prostate Symptom Score; and (iv) Hospital Anxiety and Depression Scale (HADS). RESULTS: Mean anxiety and depression scores were 4.0 and 4.7, respectively (standard deviation, 3.3 and 3.7). On the anxiety section of HADS, 291 patients (85%) scored 7 points or less; and on the depression scale, 183 (54%) patients scored 4 points or less. Those 'cases' (HADS total, >10) with psychological distress scored lower in all domains of the general and disease related health-related quality of life (HRQOL) than the 'non-cases' (HADS total, 相似文献   

The effect of the psychological status of breast cancer patients on the short-term clinical outcome after mastectomy

PURPOSE: to analyze the effect of anxiety and depression on the postoperative complications and length of hospitalization of patients with breast cancer. Beck's Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) were filled out by the patients pre-operatively. Patients were asked to rate their pain by the visual analogue scale (VAS) after surgery. Age, seroma volume, day of drain withdrawal, complications, and pathological stages were noted. The median age of 49 patients with the diagnosis of breast cancer was 51 (36-80). There was a significant correlation between the pain score and Beck, HADS, HADS (anxiety) and HADS (depression) (8 hours ; p = 0.021, 0.001, 0.004, 0.005 and 24 hours ; p = 0.005, 0.012, 0.006, 0.120). The mean HADS depression score in those patients with complications was 9.1 +/- 4.2 and that of patients with no complications was 6.6 +/- 3.1 (p = 0.047). The mean hospital stay of patients with a normal HADS score (< 19) was 2.9 +/- 1.1 days, whilst that of patients with an abnormal HADS score was 3.8 +/- 1.2 days (p = 0.016). Patients with abnormal HADS anxiety and abnormal HADS (total) scores had an earlier stage of breast cancer (p = 0.077, p = 0.063). The psychological status of breast cancer patients effects their postoperative recovery period and it is easy to diagnose these patients by some brief questionnaires.     

Psychological distress in patients undergoing surgery for urological cancer: A single centre cross-sectional study

Purpose

Interest in the disease-specific psychological well-being of patients with cancer has increased, and it has been estimated that less than half of all patients with cancer are properly identified and subsequently treated for anxiety or depression. The aim of this study is to evaluate psychological distress in uro-oncological patients undergoing different surgeries: radical cystectomy, radical prostatectomy, radical nephrectomy, or transurethral resection (TUR) before the surgery.

Screening for abdominal aortic aneurysms does not increase psychological morbidity.

Screening can lead to harmful psychological effects in the screened population--an argument used against abdominal aortic aneurysm (AAA) screening. However, there is no evidence for this in AAA screening. We applied the Hospital Anxiety and Depression Scale (HADS) to a group of men undergoing screening for AAA. The HADS questionnaire was completed by subjects found not to have AAA, subjects with known small aneurysms attending for follow-up scans, subjects with known AAA on waiting lists for surgery, and controls not involved in the screening programme. The groups were well matched for age and the number of additional diseases. There was no significant difference in the distribution of patients for anxiety and depression according to the HADS questionnaire (chi 2 test, P > 0.1). The results from this study suggest that AAA screening does not increase anxiety or depression in the screened subjects--contrary to the argument put forward against screening for this condition.     

Does active surveillance for men with localized prostate cancer carry psychological morbidity?

OBJECTIVES: To investigate, in a cross-sectional study, the prevalence of anxiety and depression in patients with localised prostate cancer managed by active surveillance, compared with those receiving immediate treatment, as active surveillance is a relatively new approach to managing this disease, designed to avoid 'unnecessary' treatment, but it is unclear whether the approach contributes to psychological distress, given that men are living with untreated cancer. PATIENTS AND METHODS: A consecutive series of 764 patients with prostate cancer were approached in outpatient clinics. Of these, 329 men with localized disease (cT1/2, N0/NX, M0/MX) meeting the study entry criteria, completed the Hospital Anxiety and Depression Scale (HADS); 100 were on active surveillance, 81 were currently receiving radical treatment (radiotherapy + neoadjuvant hormone therapy) and 148 had previously received radical radiotherapy. RESULTS: Overall, 16% (51/329) of patients met the HADS criteria for anxiety and 6% (20/329) for depression. Analyses indicated that higher anxiety scores were significantly associated with younger age (P < 0.01) and a longer interval since diagnosis (P < 0.01), but not with management by active surveillance (P = 0.38). Higher depression scores were significantly associated with a longer interval since diagnosis (P < 0.05), but not with management by active surveillance (P = 0.83). CONCLUSION: Active surveillance for managing localized prostate cancer was not associated with greater psychological distress than more immediate treatment for prostate cancer.     

Predictors of depression and anxiety symptom trajectories in the 24 months following diagnosis of breast or gynaecologic cancer

ObjectiveTo identify predictors of anxiety and depression symptom trajectories, as distinct from general distress, in the 96 weeks following diagnosis of breast or gynaecologic cancer.MethodsParticipants completed the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) and Centre for Epidemiological Studies Depression Scale (CES-D) at diagnosis and at 8-weekly intervals for 96 weeks. Linear mixed models were used to determine the effects of age, relationship status, tumour stream, cancer stage, living situation, residential area, educational status, current and previous anxiety/depression treatment and neuroticism on symptom trajectories.ResultsParticipants were 264 women with a mean (SD) age of 54 (12) years. Compared to non-treatment-receiving counterparts, women who received anxiety/depression treatment in the past had depression and anxiety symptom severity scores that were 4.58 and 1.24 higher, respectively. Women receiving such treatment at cancer diagnosis had depression and anxiety scores that were 4.34 and 2.35 points higher, respectively, than their counterparts. Compared to women with the lowest neuroticism scores, women with the highest scores scored 8.48 and 3.82 higher on the CES-D and HADS-A, respectively. Depressive severity remained stable but anxiety severity decreased as a function of neuroticism.ConclusionsIn settings with limited resources, women with high neuroticism or a depression/anxiety treatment history should be the initial target of psychological screening. Identification of women with these characteristics at the earliest point of entry into the oncology service followed by heightened surveillance and/or referral to psychosocial services may be useful to prevent chronic psychological morbidity.     

The prevalence and predictors of psychological distress in patients with early localized prostate cancer

OBJECTIVE: To determine the level of psychopathology, traumatic distress and quality of life in men with newly diagnosed clinically localized prostate cancer, the effect on these of a consultation in a combined-specialist early-prostate clinic, and predictors of psychopathology. PATIENTS AND METHODS: Eighty-eight patients were recruited from the combined clinic; they completed a battery of questionnaires including the Hospital Anxiety and Depression Scale (HADS), the revised Impact of Event Scale (IES) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, before their first appointment. Two weeks later they completed the HADS, IES and a patient-satisfaction survey. RESULTS: The overall level of psychopathology varied among the questionnaires used, from 0% on the HADS depression scale, 8% on the HADS anxiety scale and 14% on the IES. Anxiety and traumatic stress symptoms were commoner than depressive symptoms. The quality-of-life scores showed a relatively good level of functioning. Pre-morbid factors and disease status did not predict psychological distress. Younger age was mildly predictive of poorer psychological functioning. Anxiety symptoms reduced slightly after a joint clinic appointment, whereas depressive symptoms showed a slight increase. CONCLUSION: This study suggests that men with early localized prostate cancer have low levels of psychopathology overall. However, some men experience distressing psychological symptoms and it is important that future research is conducted to help develop clear guidelines on the optimal methods of detecting and managing men with prostate cancer who have mental health difficulties.     

Reassurance following breast screening recall for female survivors of Hodgkin's lymphoma

Female survivors of Hodgkin's lymphoma (HL) treated with mantle radiotherapy experience increased breast cancer risk related to radiation dose and age at diagnosis. In 2003, the Department of Health (DoH) in the UK recalled patients to explain this risk and offer screening. The aims of this paper are to describe women's emotional responses and knowledge of their personal risk following the recall. Women were interviewed before risk counselling and breast screening (Time 1, n=56) and again following screening and results (Time 2, n=50). Questionnaire measures of quality of life, anxiety, depression and cancer worries were completed at Time 2. No cases of breast cancer were identified. After the recall, 64% had learned more about late effects and 76% were reassured about their health. All but one woman intended to attend future screening. Women are keen to take advantage of screening and experience relatively little distress.     

The Course of Anxiety and Depression in Patients with Breast Cancer and Gynaecological Cancer

BACKGROUND/AIMS: The aim of this study was to assess the course of anxiety and depression in cancer patients over time and to detect determinants of the changes in the scores. PATIENTS AND METHOD: Women with breast cancer and gynaecological cancer (n = 367) were tested at the beginning (T1) and at the end (T2) of treatment in the hospital, 6 months later (T3), and 12 months later (T4), using the Hospital Anxiety and Depression Scale (HADS). RESULTS: Anxiety and depression were highest at the start of the stay in the hospital. More than half of the women are at least doubtful cases in at least one of the two HADS dimensions. The mean scores declined from T1 to T4. After 1 year, depression scores are similar to those of the general population, while anxiety scores remain elevated. The decline of the HADS scores depends on treatment, time since diagnosis, and education. CONCLUSIONS: Women receiving radio- or chemotherapy (compared with surgery only), with a long time since diagnosis, and with a low educational level are at high risk of maintaining high anxiety and depression scores over time.     

Outcome of mammography in women with large breasts

Mammography has been established as an effective screening tool for the early detection of breast cancer. Obesity may lead to increased breast size and has been linked to increased rates of breast cancer. As women with larger breasts may be predisposed to developing cancer, it is important that mammography is an appropriate test in these women. This study investigated the sensitivity and specificity of mammography in women with larger breasts in a population screening program. METHOD: Data was obtained from 848,648 eligible screening episodes of women aged over 40. Of these episodes, 758,860 were eligible for the study, with 7.2% (54,879 screens) deemed to have large breasts. Large breasts were defined as those for whom at least one large cassette was used in the mammographic process. Those women having only four standard cassettes per screen were classified as having average size breasts (703,981 screens, 92.8%). Cancer detection rates, interval cancer rates (false negatives) and recall to assessment rates were compared for women examined on standard sized cassettes versus large cassettes. Chance corrected measures of sensitivity and specificity and 95% confidence intervals (CI) were calculated for women with and without large breasts. RESULTS: The study found that the sensitivity and specificity of mammography was greater for larger breasted woman. The incidence of breast cancer was also found to be higher in woman with larger breasts in the combined population (73.1 per 100,000 (95% CI 65.9-80.2) in large breasted women versus 52.8 (95% CI 51.1-54.5) in other women) and in each of the specific age groups. This study confirms the appropriateness of mammographic screening for women with large breasts.     

Women's acceptance of MRI in breast cancer surveillance because of a familial or genetic predisposition

Magnetic resonance imaging (MRI) of the breasts is a promising screening modality for early detection in women at increased breast cancer risk. We investigated the subjective experiences with MRI and the preferences for MRI, mammography or clinical breast examination in 178 high-risk women adhering to a breast cancer surveillance programme. MRI was reported to cause limited discomfort. About 44% preferred MRI as a screening test (mammography: 14%). MRI provided the most reassurance of breast cancer being absent in case of a favourable test result. MRI seems to be acceptable as a screening test for women at increased breast cancer risk and is preferred by them over mammography.     

Psychosocial Consequences of Genetic Counseling: A Population-Based Follow-up Study

Abstract:  We aimed to examine the psychosocial impact of genetic counseling for hereditary breast and ovarian cancer 1 year following genetic counseling. We conducted a population-based prospective follow-up study of 213 women who received genetic counseling for hereditary breast and ovarian cancer, 319 women who underwent mammography (Reference Group I), and a random sample of 1,070 women from the general population (Reference Group II). The prevalence of anxiety decreased by 4.7% (95% CI: −3.5; 12.8) from baseline to 1 year of follow-up in the Genetic Counseling Group. Likewise, it decreased by 2.5% (95% CI: −4.5; 9.5) in Reference Group I and by 1.1% (95% CI: −2.3; 4.7) in Reference Group II. The prevalence of depression increased equally (1–3%) in the three study groups. 52% of the women referred for genetic counseling experienced cancer-specific distress at baseline and this proportion decreased to 41% after 12 months of follow-up. This decrease of 10.8% (95% CI: 1.4; 20.8) exceeded the decrease observed in both Reference Groups. However, it was statistically significant only in the case of Reference Group II (p = 0.006). Our findings indicate that genetic counseling can help alleviate cancer-specific distress among women with a family history of breast and ovarian cancer. Further, genetic counseling does not appear to have an adverse impact on general anxiety, symptoms of depression, or health-related quality of life.     

Knowledge of Density and Screening Ultrasound

To determine breast density awareness and attitudes regarding supplemental breast ultrasound screening since implementation of the nation's first breast density notification law, Connecticut Public Act 09‐41. A self‐administered survey was distributed at a Connecticut academic breast imaging center between February 2013 and February 2014. Women with prior mammography reports describing heterogeneous or extremely dense breast tissue were invited to participate when presenting for screening mammography, screening ultrasound, or both. Data were collected on breast density awareness, history of prior ultrasounds, attitudes toward ultrasound and breast‐cancer risk, and demographics. Data were collected from 950 completed surveys. The majority of surveyed women (92%) were aware of their breast density, and 77% had undergone a prior screening ultrasound. Forty‐three percent of participants who were aware of their breast density also expressed increased anxiety about developing breast cancer due to having dense breast tissue. Caucasian race and higher education were significantly associated (p < 0.05) with knowledge of personal breast density (93% and 95%, respectively) and having a prior screening breast ultrasound (79% and 80%, respectively). Patients with less than a college degree (82%) were significantly more likely to rely exclusively on their provider's recommendation regarding obtaining screening ultrasound (p < 0.05). Breast density awareness is strongly associated with higher education, higher income, and Caucasian race. Non‐Caucasian patients and those with less than a college education rely more heavily on their physicians’ recommendations regarding screening ultrasound. Among women aware of their increased breast density, nearly half reported associated increased anxiety regarding the possibility of developing breast cancer.     

Reduction in advanced breast cancer after introduction of a mammography screening program in Tyrol/Austria

BackgroundWe analysed all female breast cancer (BC) cases in Tyrol/Austria regarding the shift in cancer characteristics, especially the shift in advanced BC, for the group exposed to screening as compared to the group unexposed to screening.MethodsThe analysis was based on all BC cases diagnosed in women aged 40–69 years, resident in Tyrol, and diagnosed between 2009 and 2013. The data were linked to the Tyrolean mammography screening programme database to classify BC cases as “exposed to screening” or “unexposed to screening”. Age-adjusted relative risks (RR) were estimated by relating the exposed to the unexposed group.ResultsIn a total of about 145,000 women aged 40–69 years living in Tyrol during the study period, 1475 invasive BC cases were registered. We estimated an age-adjusted relative risk (RR) for tumour size ≥ 21 mm of 0.72 (95% confidence interval (CI) 0.60 to 0.86), for metastatic BC of 0.27 (95% CI 0.17 to 0.46) and for advanced BC of 0.83 (95% CI 0.71 to 0.96), each comparing those exposed to those unexposed to screening, respectively.ConclusionIn our population-based registry analysis we observed that participation in the mammography screening programme in Tyrol is associated with a 28% decrease in risk for BC cases with tumour size ≥ 21 mm and a 17% decrease in risk for advanced BC. We therefore expect the Tyrolean mammography programme to show a reduction in BC mortality.     

Systematic review of 3D mammography for breast cancer screening

This review investigated the relative performance of digital breast tomosynthesis (DBT) (alone or with full field digital mammography (FFDM) or synthetic digital mammography) compared with FFDM alone for detecting breast cancer lesions in asymptomatic women. A systematic review was carried out according to systematic reviewing principles provided in the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. A protocol was developed a priori. The review was registered with PROSPERO (number CRD42014013949). Searches were undertaken in October 2014. Following selection, five studies were eligible. Higher cancer detection rates were observed when comparing DBT + FFDM with FFDM in two European studies: the summary difference per 1000 screens was 2.43 (95% CI: 1.8 to 3.1). Both European studies found lower false positive rates for individual readers. One found a lower recall rate based on conditional recall. The second study was not designed to compare post-arbitration recall rates between FFDM and DBT + FFDM. One European study presented data on interval cancer rates; sensitivity and specificity for DBT + FFDM were both higher compared to FFDM. One large multicentre US study showed a higher cancer detection rate for DBT + FFDM, while two smaller US studies did not find statistically significant differences. Reductions in recall and false positive rates were observed in the US studies in favour of DBT + FFDM. In comparison to FFDM, DBT, as an adjunct to FFDM, has a higher cancer detection rate, increasing the effectiveness of breast cancer screening. Additional benefits of DBT may also include reduced recalls and, consequently, reduced costs and distress caused to women who would have been recalled.     

Psychological reactions to thermography and mammography

Psychological distress and illness attitudes were investigated in women undergoing thermography and mammography by means of two self-rating scales: the Symptom Questionnaire (SQ) and the Illness Attitude Scales (IAS). After receiving normal results from thermography, a significant decrease in anxiety, depression, somatic symptoms, hostility, worry about illness, concern about pain, and fear of dying took place. Women who, because of the thermography results, required mammography, displayed significantly less distress and fewer fears before mammography than before thermography.