101
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Taylor KL, Shelby R, Gelmann E, McGuire C. Quality of life and trial adherence among participants in the prostate, lung, colorectal, and ovarian cancer screening trial. J Natl Cancer Inst 2004; 96:1083-94. [PMID: 15265970 DOI: 10.1093/jnci/djh194] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The National Cancer Institute's Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial was designed to examine whether annual screening tests for these four tumor sites result in reduced disease-related mortality. We assessed the impact of trial participation on both health-related quality of life (HRQL) and trial adherence. METHODS Participants (N = 432; 217 in the control arm and 215 in screening arm) were accrued from the Georgetown University PLCO site from May through December 1998. Screening-arm participants were interviewed by telephone at baseline (prescreening), shortly after notification of screening results (short-term follow-up), and 9 months after notification of screening results (intermediate-term follow up). Control-arm participants completed a baseline and 1-year follow-up assessment. Logistic regression analyses were conducted. RESULTS Participants reported high levels of HRQL and satisfaction with their decision to participate. Screening-arm participants with abnormal screening results had a higher level of intrusive thoughts about cancer than those with all normal results (odds ratio [OR] = 2.9, 95% confidence interval [CI] = 1.3 to 6.3) at the short-term follow-up but not at the intermediate-term follow-up (when abnormal test results were known to be false positive; OR = 1.9, 95% CI = 0.89 to 4.2). Trial adherence was statistically significantly better among participants who had received all normal results in the previous year's screening tests (93.7% versus 78.7%; OR = 3.7, CI = 1.1 to 12.0) than in those who received at least one abnormal result. In the control arm, adherence (defined as returning annual questionnaires) was positively associated with education (OR = 3.4, 95% CI = 1.4 to 8.4) and sex, with women being more likely to return questionnaires than men (OR = 2.1, 95% CI = 1.05 to 4.4). CONCLUSIONS It is feasible to collect HRQL measures as part of a large cancer screening trial. Prior abnormal screening results were related to short-term HRQL but not to intermediate-term HRQL. Trial adherence was poorer among those who had received previous false-positive results. These results suggest several methods for improving adherence in this and other subgroups.
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Affiliation(s)
- Kathryn L Taylor
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, 2233 Wisconsin Ave., NW, Ste. 317, Washington, DC 20007, USA.
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102
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Davis S, Stewart S, Bloom J. Increasing the accuracy of perceived breast cancer risk: results from a randomized trial with Cancer Information Service callers. Prev Med 2004; 39:64-73. [PMID: 15207987 DOI: 10.1016/j.ypmed.2004.02.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Results are reported from a randomized trial designed to increase the accuracy of perceived breast cancer risk among callers to the NCI's Cancer Information Service (CIS) (n = 392). METHODS CIS callers assigned to the intervention group (n = 200) received a brief educational intervention and an estimate of breast cancer risk over the telephone at the end of usual service. Follow-up interviews were completed by telephone at 1 month (n = 367). RESULTS On average, women overestimated their risk by 25 percentage points. Eighty percent of the respondents rated their risk of breast cancer higher than did the assessment tool. Women rated their risk higher if they were under age 50 (P = 0.025) or had a first-degree family history of breast cancer (P = 0.0001), and rated their risk lower if they were Latina (P = 0.050) or Asian/other race/ethnicity (P = 0.013). Women with a first-degree family history of breast cancer in the intervention group significantly reduced their risk overestimate compared to those in the control group (-12.5 vs. 2.8 percentage points, P = 0.006). CONCLUSIONS This intervention was unique because it was delivered in an ongoing service setting. It should be further tested in diverse populations.
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Affiliation(s)
- Sharon Davis
- National Cancer Institute's Cancer Information Service, Northern California Cancer Center, Union City, CA 94587, USA.
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103
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Abstract
Current American Cancer Society guidelines recommend monthly performance of breast self-examination (BSE) for women over 20 years of age. While the experience of a benign breast biopsy can result in elevated levels of distress, the impact of benign biopsy upon breast cancer (BC) screening behavior is not well known. The present study examined frequency of BSE practice in 102 women after benign breast biopsy (biopsy group). Telephone interviews were completed a mean of 21 days (initial interview) and 8 months after biopsy (follow-up interview). A healthy comparison (HC) group of women (n = 76) without a history of breast biopsy completed an initial interview only. Information regarding distress, dispositional characteristics, BC screening-related attitudes and behaviors, and subjective and objective risk for BC was collected. Results indicated that the biopsy and HC groups did not differ in typical (i.e., prebiopsy) practice of BSE. However, practice of BSE changed after biopsy with a general trend toward a decrease in BSE frequency. Only 8% of women in the biopsy group reported appropriate (once per month) practice of BSE at the 8-month Follow-up while 28% reported appropriate practice at the initial interview. Decreases in BSE performance after biopsy were characteristic of younger women, women who lacked confidence in the ability to perform BSE correctly, and women whose biopsy was preceded by discovery of a breast lump or abnormality during BSE. Results suggest the potential value of a psychoeducational intervention after biopsy to enhance appropriate performance of BSE.
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Affiliation(s)
- Abbie O Beacham
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA.
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104
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Loader S, Shields CG, Rowley PT. Impact of Genetic Testing for Breast–Ovarian Cancer Susceptibility. ACTA ACUST UNITED AC 2004; 8:1-12. [PMID: 15140369 DOI: 10.1089/109065704323015987] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Previously, we have reported a clinical trial in which any woman in a defined geographic region who had a qualifying family history and who was referred by her physician or who was identified through a regional cancer registry was offered free genetic counseling, BRCA testing, and recommendations based on test results. Each family was represented by one affected and one unaffected person. Of the 87 families actually tested, 13 were found to have deleterious mutations. To assess the impact of the counseling and testing process, we contacted the tested individuals 1 month and 1 year after receiving the test result and those with an abnormal test result after 4 years. Index subjects, we found, differed significantly from relatives. Before coming for counseling, index subjects perceived both their general health and emotional health as worse than did their relatives. After counseling and testing, index subjects continue to worry more about breast cancer than do relatives. Affected subjects, we found, differed significantly from unaffected subjects. Before counseling, affected subjects knew more about breast cancer, perceived their general health as poorer, and reported greater adherence to recommended breast cancer surveillance than did unaffected subjects. After counseling and testing, affected subjects were less satisfied than unaffected subjects with having been tested. This study indicates that the group most prone to distress by cancer risk genetic counseling and testing is not the recruited relatives, nor even those affected with cancer, but rather the index patients themselves. The index patients, i.e., the ones who want the risk information most, appear to undergo the most stress in obtaining it.
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Affiliation(s)
- Starlene Loader
- Department of Medicine, Division of Genetics, University of Rochester School of Medicine, Rochester, NY 14642, USA
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105
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Bowen DJ, Burke W, McTiernan A, Yasui Y, Andersen MR. Breast cancer risk counseling improves women's functioning. PATIENT EDUCATION AND COUNSELING 2004; 53:79-86. [PMID: 15062908 DOI: 10.1016/s0738-3991(03)00122-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2002] [Revised: 02/19/2003] [Accepted: 03/05/2003] [Indexed: 05/24/2023]
Abstract
Helping people cope with health risks is an important area for research and practice. Counseling offers people the opportunity to relieve their distress and improve the ways in which they manage their health issues. This study was a randomized test of two different counseling methods, genetic and psychosocial counseling, compared to a control group. Eligibility requirements included being between 18 and 74 years old, having at least one relative with breast cancer, not having a family history consistent with carrying a BRCA1/2 mutation for breast cancer risk, having no personal history of breast or ovarian cancer, living within 60 miles of the research institute, and willingness to complete the research requirements of the project. Perceived risk decreased by 50% for participants in the two counseling groups relative to comparison participants. Cancer worry decreased in both counseling groups by one scale point (P < 0.05). These results indicate that counseling can relieve women's negative reactions to breast cancer risk.
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Affiliation(s)
- Deborah J Bowen
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, MP-900, Seattle, WA 98109, USA.
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106
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Norman P, Hoyle S. The Theory of Planned Behavior and Breast Self-Examination: Distinguishing Between Perceived Control and Self-Efficacy. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2004. [DOI: 10.1111/j.1559-1816.2004.tb02565.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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107
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Cullen J, Schwartz MD, Lawrence WF, Selby JV, Mandelblatt JS. Short-term impact of cancer prevention and screening activities on quality of life. J Clin Oncol 2004; 22:943-52. [PMID: 14990651 DOI: 10.1200/jco.2004.05.191] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There are few data on the short-term effects of participating in cancer prevention activities, undergoing genetic risk assessment, or having routine screening. The objective of this article is to systematically review existing research on short-term effects of prevention, genetic counseling and testing, and screening activities on quality of life. METHODS We conducted a MEDLINE search for original research studies that were published between January 1, 1985, and December 31, 2002, and conducted in North America or Western Europe. Data were abstracted and summarized using a standardized format. RESULTS We reviewed 210 publications. Most studies focused on psychological states (anxiety, depression), symptoms, or general health status. One hundred thirty-one studies used 51 previously validated noncancer instruments. Many researchers (12.6%) also added cancer-specific measures, such as perceived cancer risk or symptom indices. Only one study measured satisfaction or quality of provider-client communication. While one report examined lost workdays, no other economic consequences of short-term outcomes were evaluated. Among seven studies that assessed short-term outcomes preferences, only four specifically used time trade-off or linear rating scale methods. No study used standard gamble or willingness-to-pay methods. The overwhelming majority of research indicated that short-term effects were transient. Only two studies linked short-term effects to long-term cancer-related health behaviors such as repeat screening. CONCLUSION There is considerable heterogeneity in short-term outcome measurement. Clinicians need to be aware of potential for short-term, transient adverse effects. The impact of short-term experiences should to be linked to long-term health status and use of services.
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Affiliation(s)
- Jennifer Cullen
- Department of Oncology, Georgetown University, 2233 Wisconsin Ave NW, Suite 440, Washington, DC, USA.
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108
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Keenan LA, Lesniak KT, Guarnaccia CA, Althaus B, Ethington G, Blum JL. Family Environments of Women Seeking BRCA1/BRCA2
Genetic Mutation Testing: An Exploratory Analysis. J Genet Couns 2004; 13:157-76. [PMID: 15604630 DOI: 10.1023/b:jogc.0000018824.04992.7b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although there is some understanding of the shared characteristics and predictors of psychological distress of women participating in hereditary breast and ovarian cancer registries, these same characteristics are only beginning to be identified in research on community women seeking genetic testing for BRCA1/BRCA2 gene mutations. This study provides an initial exploration of characteristics associated with family environments for 51 community women waiting to receive such genetic testing results. Thirty-four of the 36 women classified on family environment type of the Family Environment Scale (FES) were from Personal Growth-Oriented families. Comparisons of women with and without personal cancer histories resulted in a trend for women with personal cancer histories to be classified as from Independence-Oriented families. Reported distress appears to vary for different family emphases based on family and personal cancer history. A moral-religious family emphasis consistently appeared to be associated with decreased psychological distress. Preliminary analyses comparing these community women (who were not part of a hereditary registry but were self- or physician-referred) seeking genetic testing with normal and distressed family means found that increased cohesion and expressiveness may be related to decreased conflict, indicative of potentially supportive family environments for these women. When compared with normative data, a subset consisting of the Ashkenazi Jewish women showed a trend of less cohesion than normal families, but similar cohesion levels as distressed families.
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Affiliation(s)
- Lisa A Keenan
- Department of Neuropsychology, Transitional Learning Center, Galveston, Texas 77550, USA.
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109
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Gilbar O. Do attitude toward cancer, sense of coherence and family high risk predict more psychological distress in women referred for a breast cancer examination? Women Health 2004; 38:35-46. [PMID: 14655793 DOI: 10.1300/j013v38n02_03] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The study focuses on the connection between attitude toward cancer, sense of coherence and family history of breast cancer, on the one hand, and psychological distress on the other among women who are referred for breast cancer examination following a medical examination prompted by a complaint of "feeling something in the breast." METHOD A sample of 314 women referred to a breast health clinic in northern Israel completed questionnaires that measured psychological distress (Brief Symptom Inventory), personal resources (the Sense of Coherence Scale), and mindset (Attitude to Cancer Treatment Scale). RESULTS A weak sense of coherence and a more negative attitude toward cancer (i.e., viewing victims of cancer with pity; viewing the illness as a death sentence; harboring a fear of death from cancer) predict a high level of psychological distress while awaiting an examination. A family history of breast cancer, or a first-time examination, were not found to be predictors of greater psychological distress. CONCLUSION Learning cognitive behavioral coping skills, as well as access to information on cancer and treatment in order to change attitude toward cancer, are needed.
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Affiliation(s)
- Ora Gilbar
- School of Social Work, University of Haifa, Haifa, Israel
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110
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Andersen MR, Bowen D, Yasui Y, McTiernan A. Awareness and concern about ovarian cancer among women at risk because of a family history of breast or ovarian cancer. Am J Obstet Gynecol 2004; 189:S42-7. [PMID: 14586320 DOI: 10.1067/s0002-9378(03)01078-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Research on women at risk for breast cancer because of family history suggests that a substantial proportion need education and counseling to assist them in their efforts to understand their risk of breast cancer and that some do not get appropriate breast cancer screening. Although women at high genetic risk for breast cancer are at elevated risk for ovarian cancer as well, few studies have examined these women's needs for education and counseling about ovarian cancer risk. This study examined awareness of ovarian cancer, perceived risk of breast and ovarian cancer, interest in genetic testing, and use of screening for breast and ovarian cancer in a population-based sample of women at high risk for breast and ovarian cancer because of a strong family history of cancer at one or both sites. We found that most high-risk women are not getting the information and care they need with respect to their risk for ovarian cancer. Almost 75% have not heard much about their risk for ovarian cancer. More than 90% failed to use 1 or another of 2 possible tests used for ovarian cancer screening regularly.
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Affiliation(s)
- M Robyn Andersen
- Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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111
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Buxton JA, Bottorff JL, Balneaves LG, Richardson C, McCullum M, Ratner PA, Hack T. Women's perceptions of breast cancer risk: are they accurate? Canadian Journal of Public Health 2004. [PMID: 14700240 DOI: 10.1007/bf03405078] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective was to compare women's personal estimates of their risk with objective breast cancer risk estimates and to describe the risk factors for breast cancer identified by women. METHODS Telephone survey of a random sample of 761 rural and urban women with no history of breast cancer. Survey instrument included measures of perceptions of lifetime risk for breast cancer for themselves and for the average woman, perceptions of risk factors that influenced their risk and the average woman's risk for breast cancer. Objective estimates of breast cancer risk were calculated using the Gail et al. algorithm. Descriptive statistics and multiple linear regression were used to analyze the data. RESULTS Women's estimates of their own lifetime risk for breast cancer were significantly higher than their Gail model risk estimates (mean difference = 19%, p < 0.001). The women's personal breast cancer risk estimates were lower than estimates of risk for a hypothetical average woman (mean difference = -8%, p < 0.001). Fifty percent of the sample reported a perceived risk estimate at least 15% above their Gail risk estimate. The risk factors for breast cancer most frequently identified included family history, nutrition/diet, smoking, lifestyle, environment, stress and age. Although the risk factors used to calculate the Gail model risk estimates were reported by some study participants, these women consistently identified only family history as their personal risk factor. CONCLUSION Women have difficulty accurately estimating their breast cancer risk and identifying known risk factors for breast cancer. Individual risk information may be more useful in enhancing accurate risk perceptions than the "1 in 9" message.
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Affiliation(s)
- Jane A Buxton
- Department of Health Care and Epidemiology, University of British Columbia, Mather Building, 5804 Fairview Ave., Vancouver, BC V6T 1Z3.
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112
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Gurevich M, Devins GM, Wilson C, McCready D, Marmar CR, Rodin GM. Stress response syndromes in women undergoing mammography: a comparison of women with and without a history of breast cancer. Psychosom Med 2004; 66:104-12. [PMID: 14747644 DOI: 10.1097/01.psy.0000109907.78754.5a] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the incidence, severity, and correlates of acute stress responses in women undergoing diagnostic mammographic surveillance and to explore the moderating impact of physician support on these symptoms. METHODS Sixty-six female breast cancer outpatients (at least 12 months after diagnosis and primary treatment) and 69 healthy women undergoing mammographic surveillance completed measures of: acute stress response, somatization, trauma history, psychiatric history, social support, and physician satisfaction. RESULTS Previous cancer, pre-mammography breast complaints, lower income, previous psychiatric medication use, greater instrumental support, greater somatization, greater perceived physician disengagement, and less perceived physician support were all associated with increased stress responses. Among women with a previous cancer diagnosis, those with greater distress reported higher levels of physician support. In contrast, among those without a previous cancer diagnosis, those with greater perceived physician support reported less distress. CONCLUSIONS These findings suggest that cancer-related cues, such as follow-up surveillance, may trigger a sensitizing response in women with a previous cancer diagnosis. The association of distress with physician support may arise from the responsiveness of physicians to identified distress, from increased help-seeking behavior by those who are distressed, or both. The benefit of support provided by health care professionals to those at risk of developing stress response syndromes deserves further study.
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Affiliation(s)
- Maria Gurevich
- Psychosocial Oncology and Palliative Care Program, Princess Margaret Hospital, Toronto, Ontario, Canada.
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113
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Bowen DJ, Alfano CM, McGregor BA, Andersen MR. The relationship between perceived risk, affect, and health behaviors. ACTA ACUST UNITED AC 2004; 28:409-17. [PMID: 15582264 DOI: 10.1016/j.cdp.2004.08.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2004] [Indexed: 10/26/2022]
Abstract
In this study, we examined the relationship between affect and health behaviors. The study participants were women (n = 1366), aged 18-74 years, who had not been previously diagnosed with breast cancer, who had a working telephone number and address, who spoke English, who planned to be in their present residence for at least 1 year, and who were willing to complete the survey requirements. General anxiety was a significant predictor of eating a low-fat diet, in a quadratic manner (p < .05). General anxiety and breast cancer worry were significant predictors of breast self-examination, in a quadratic fashion (p < .05). None of four independent variables, perceived risk, cancer worry, general anxiety, and general depression scores, were significantly related to mammography use, physical activity, or fruit and vegetable consumption. We must look beyond risk perceptions and family history to understand motivations for health behaviors.
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Affiliation(s)
- Deborah J Bowen
- Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, M3-B232, Seattle, WA 98109-1024, USA.
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114
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Sheinfeld Gorin S, Albert SM. The meaning of risk to first degree relatives of women with breast cancer. Women Health 2003; 37:97-117. [PMID: 12839310 DOI: 10.1300/j013v37n03_07] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Breast cancer represents a serious health concern for women. It is estimated that hereditary breast cancer accounts for approximately 5-10% of all breast cancer cases and as many as 25% of early-onset cases. We conducted a qualitative study of 26 first degree relatives of women with breast cancer (FDRs) in order to gain a deeper understanding of the effect of risk perception on their screening adherence. The method relied upon semi-structured, in-depth, face-to-face interviews with first degree relatives of women with breast cancer. We characterized FDRs by their response to a single query about their perceived risk. "Risk adopters" (N = 13) were defined as those who expressed a lifetime risk of breast cancer of 50% or more, and "normalizers" (N = 13) were those who indicated a lifetime risk of 49% or less. We conducted content analysis on the responses to the open-ended queries concerning perceived risk for breast cancer, searching for consistent themes among the responses. Surveillance behaviors were high among these FDRs relative to population-based comparisons. The difference between perceived and objective risk for breast cancer was significantly greater among risk adopters than normalizers (p < .0001). Three themes, derived from a content analysis of the FDR's natural language, further distinguish the two groups of women from one another: (1) causal attributions; (2) acceptance of labeling by the physician or other health care provider; and (3) current or remembered surveillance reminders from salient members of the social support network. We suggest different health care provider approaches to FDRs who are normalizers and those who are risk adopters, as well as additional studies of the impact of risk status (as manifest in the FDR's natural language) and surveillance behaviors, over time, among more diverse subgroups.
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Affiliation(s)
- Sherri Sheinfeld Gorin
- Mailman School of Public Health of Columbia University, 409, 600 West 168th Street, New York, NY 10032, USA.
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115
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Wonderlick AL, Fine BA. Knowledge of Breast Cancer Genetics Among Breast Cancer Patients and First-Degree Relatives of Affected Individuals. J Genet Couns 2003; 6:111-30. [DOI: 10.1023/a:1025651816768] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Aimee L. Wonderlick
- ; Section of Reproductive Genetics, Department of Obstetrics and Gynecology; Northwestern University Medical School; Chicago Illinois
| | - Beth A. Fine
- ; Section of Reproductive Genetics, Department of Obstetrics and Gynecology; Northwestern University Medical School; Chicago Illinois
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116
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Bowen DJ, Helmes A, Powers D, Andersen MR, Burke W, Mctiernan A, Durfy S. Predicting Breast Cancer Screening Intentions and Behavior with Emotion and Cognition. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2003. [DOI: 10.1521/jscp.22.2.213.22875] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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117
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Gil F, Méndez I, Sirgo A, Llort G, Blanco I, Cortés-Funes H. Perception of breast cancer risk and surveillance behaviours of women with family history of breast cancer: A brief report on a Spanish cohort. Psychooncology 2003; 12:821-7. [PMID: 14681955 DOI: 10.1002/pon.704] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Women with a family history of breast cancer (FHBC) are at increased risk for developing this disease. In this study, we have investigated the differences between two groups of women; those with family history of breast cancer (N=42) and women at population risk (N=42) in a Spanish cohort. Questionnaires assessed distress, perception of breast cancer risk, screening behaviours, coping skills, personality and quality of life. Neither group received genetic counselling before or after this study. Women with FHBC overestimated their risk of developing breast cancer. They report a subjective risk of developing breast cancer of 50%, with their actual risk, using the risk tables elaborated by Claus et al., being only 15% (p<0.05). Discriminant function analysis revealed the patients' information about breast cancer, worries about breast cancer, perception of risk based on family history, perception of lifetime risk of breast cancer and quality of life were the five variables that distinguished between both groups. Only 34% of women in the FHBC group performed monthly breast self-examination, 24% (10 subjects) had never attended previously for clinical breast examination and 45% (19 subjects) had never undergone a mammogram. This group of women had a significantly lower level of general satisfaction (p<0.05), an indicator of Quality of Life. The results support the need for developing psychological intervention for women with family history of breast cancer in order to increase adherence to surveillance behaviours, reduce distress, improve quality of life, and assure the earliest detection of breast cancer.
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Affiliation(s)
- Francisco Gil
- Psycho-Oncology Unit, Institut Català d'Oncologia, Barcelona, Spain.
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118
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Karp J, Brown KL, Sullivan MD, Massie MJ. The Prophylactic Mastectomy Dilemma: A Support Group for Women at High Genetic Risk for Breast Cancer. J Genet Couns 2003; 8:163-73. [DOI: 10.1023/a:1022834706495] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jane Karp
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center; Adjunct Attending; New York New York 10021
- ; Clinical Instructor in Psychiatry, New York University Medical Center; New York New York 10021
| | - Karen L. Brown
- ; Cancer Genetic Counseling, and Instructor, Department of Human Genetics; The Mount Sinai School of Medicine; New York New York 10029; at the time of this project Ms. Brown was Program Coordinator, Clinical Genetics Service, Department of Human Genetics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
| | - Margaret D. Sullivan
- ; Department of Volunteer Resources, Memorial Sloan-Kettering Cancer Center; New York New York 10021
- ; Department of English; Hunter College of the City University of New York; New York New York 10021
| | - Mary Jane Massie
- ; Barbara White Fishman Center for Psychological Counseling, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center; New York New York 10021
- ; Cornell University Medical College; New York New York 10021
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119
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Schwartz MD, Taylor KL, Willard KS. Prospective association between distress and mammography utilization among women with a family history of breast cancer. J Behav Med 2003; 26:105-17. [PMID: 12776381 DOI: 10.1023/a:1023078521319] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this study we sought to evaluate the prospective association between psychological distress and mammography utilization among women with a family history of breast cancer. We evaluated the association of cancer worry, cancer-specific distress, and general distress with mammography utilization after controlling for potential confounders. The results revealed that 74% of our sample had obtained a mammogram within 12 months of the baseline assessment. Logistic regression models revealed that after controlling for potential confounding variables, cancer worry and general distress were independent predictors of mammography utilization. Specifically, women who reported higher levels of worry and/or distress at baseline were less likely to report having received a mammogram in the 12 months following the baseline assessment. These results are in contrast to the only other prospective study in this population. Additional research is needed to determine the prospective association between distress and adherence and to identify potential mechanisms for such an association.
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Affiliation(s)
- Marc D Schwartz
- Lombardi Cancer Center and Georgetown University School of Medicine, Washington, District of Columbia, USA.
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120
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Cohen M. First-degree relatives of breast-cancer patients: cognitive perceptions, coping, and adherence to breast self-examination. Behav Med 2003; 28:15-22. [PMID: 12244641 DOI: 10.1080/08964280209596394] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The author assessed patterns of breast self-examination (BSE) related to cognitive appraisal, coping, and emotional distress in 80 women with first-degree relatives who were breast-cancer patients and 47 matched controls. Participants with first-degree relatives adhered to BSE better than did women with no family history of breast cancer, and women whose relatives had recurrent or metastatic disease performed more BSE than those whose relatives were currently disease free. Greater adherence to BSE was associated with lower levels of depression, more problem-focused coping, older age, and more education. In the women with first-degree relatives, BSE was also associated with higher perceptions of (a) control over prevention, (b) risk for breast cancer, and (c) higher levels of state anxiety. Perception of control, problem-focused coping, depression, and anxiety predicted 35% of the variance in adherence to BSE. The findings suggest that cognitive appraisal, coping strategies, and levels of emotional distress should be considered in designing programs for enhancing adherence to early detection procedures.
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Affiliation(s)
- Miri Cohen
- School of Social Work, Faculty of Social Welfare and Health Studies, Haifa University, Mount Carmel, Israel.
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121
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Abstract
Over the past 5 years, tests for germline (heritable) gene mutations associated with high risk of chronic diseases, such as breast cancer, have become increasingly available. Appropriately used, tests for such mutations could lead to reductions in disease morbidity and mortality. Population screening has been proposed for some cancer-related mutations; however, not all populations are suitable for such screening. The benefits of screening and preventive treatments for individuals with cancer-related mutations in different populations depend on the prevalence and penetrance of the mutation, the mortality associated with the disease, the age of the person screened at testing, and the potential effects of preventive measures on risk of developing the disease, quality of life, and costs. The criteria normally used to assess cancer screening tests can be applied, with some modifications, to tests for cancer-related genetic mutations and can help physicians, insurance companies, and health-policy makers to decide whether or not specific genetic tests should be used to screen specific populations.
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Affiliation(s)
- Victor R Grann
- Health Outcomes Research, Herbert Irving Comprehensive Cancer Center and Clinical Medicine and Epidemiology, College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Janda M, Stanek C, Newman B, Obermair A, Trimmel M. Impact of videotaped information on frequency and confidence of breast self-examination. Breast Cancer Res Treat 2002; 73:37-43. [PMID: 12083630 DOI: 10.1023/a:1015264103561] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Videotaped education materials to teach breast self-examination (BSE) are used worldwide. However, evaluation of videotaped BSE instructions is lacking. METHODS Premenopausal women (mean age 33.4+/-11.2 years) without history of breast cancer were approached to participate in this experimental study and randomly assigned to a video intervention group (VG; n = 130: length of the video = 15 min) or non-video comparison group (NVG; n = 121). All participants answered a questionnaire on BSE behavior and health beliefs. No additional training was given. The total duration of the session including completion of the questionnaire was 15 min for the NVG and 30 min for the VG. Three months later, changes in BSE behavior were compared in the two groups. The influence of health beliefs on actual BSE behavior was investigated as well. RESULTS Women of both the VG and NVG performed BSE significantly more frequently at follow-up than at baseline. Analysis of covariance, using the baseline BSE-frequency as co-variate and the follow-up BSE frequency as the dependent variable, revealed that women in the VG (adjusted mean = 7.9 times per year, 95%CI = 6.5-9.4) performed BSE more frequently than women of the NVG (adjusted mean = 6.1 times per year, 95%CI = 4.6-7.5) (F = 4.2, df= 2, p = 0.02). Among motivational predictors, having an example of a role model (modeling) was shown by regression analysis to explain the greatest amount of variance (13%) in BSE frequency. CONCLUSION Use of an educational videotape increased the frequency of BSE among premenopausal women.
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Affiliation(s)
- Monika Janda
- Centre for Public Health Research, Queensland University of Technology, Brisbane, Australia
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123
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Foster C, Evans DGR, Eeles R, Eccles D, Ashley S, Brooks L, Davidson R, Mackay J, Morrison PJ, Watson M. Predictive testing for BRCA1/2: attributes, risk perception and management in a multi-centre clinical cohort. Br J Cancer 2002; 86:1209-16. [PMID: 11953874 PMCID: PMC2375339 DOI: 10.1038/sj.bjc.6600253] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2001] [Revised: 01/10/2002] [Accepted: 02/25/2002] [Indexed: 01/03/2023] Open
Abstract
The aim of this multi-centre UK study is to examine the attributes of a cohort offered predictive genetic testing for breast/ovarian cancer predisposition. Participants are adults unaffected with cancer from families with a known BRCA1/2 mutation. This is the first large multi-centre study of this population in the UK. The study evaluates mental health, perceived risk of developing cancer, preferred risk management options, and motivation for genetic testing. Participants were assessed when coming forward for genetic counselling prior to proceeding to genetic testing. Three hundred and twelve individuals, 76% of whom are female, from nine UK centres participated in the study. There are no gender differences in rates of psychiatric morbidity. Younger women (<50 years) are more worried about developing cancer than older women. Few women provide accurate figures for the population risk of breast (37%) or ovarian (6%) cancer but most think that they are at higher risk of developing breast (88%) and ovarian (69%) cancer than the average woman. Cancer related worry is not associated with perceived risk or uptake of risk management options except breast self-examination. The findings indicate that younger women may be particularly vulnerable at the time of the offer of a predictive genetic test.
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Affiliation(s)
- C Foster
- Psychology Research Group and Cancer Genetics Team, The Institute of Cancer Research, Sutton SM2 5PT, UK
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Paterson JM, Llewellyn-Thomas HA, Naylor CD. Using disease risk estimates to guide risk factor interventions: field test of a patient workbook for self-assessing coronary risk. Health Expect 2002; 5:3-15. [PMID: 11906538 PMCID: PMC5060131 DOI: 10.1046/j.1369-6513.2002.00148.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To assess the feasibility and acceptability of a patient workbook for self-assessing coronary risk. DESIGN Pilot study, with post-study physician and patient interviews. SETTING AND SUBJECTS Twenty southern Ontario family doctors and 40 patients for whom they would have used the workbook under normal practice conditions. INTERVENTIONS The study involved convening two sequential groups of family physicians: the first (n=10) attended focus group meetings to help develop the workbook (using algorithms from the Framingham Heart Study); the second (n=20) used the workbook in practice with 40 patients. Follow-up interviews were by interviewer-administered questionnaire. MAIN OUTCOMES MEASURES Physicians' and patients' opinions of the workbook's format, content, helpfulness, feasibility, and potential for broad application, as well as patients' perceived 10-year risk of a coronary event measured before and after using the workbook. RESULTS It took an average of 18 minutes of physician time to use the workbook: roughly 7 minutes to introduce it to patients, and about 11 minutes to discuss the results. Assessments of the workbook were generally favourable. Most patients were able to complete it on their own (78%), felt they had learned something (80%) and were willing to recommend it to someone else (98%). Similarly, 19 of 20 physicians found it helpful and would use it in practice with an average of 18% of their patients (range: 1-80%). The workbook helped to correct misperceptions patients had about their personal risk of a coronary event over the next 10 years (pre-workbook (mean (SD) %): 35.2 (16.9) vs. post-workbook: 17.3 (13.5), P < 0.0001; estimate according to algorithm: 10.6 (7.6)). CONCLUSIONS Given a simple tool, patients can and will assess their own risk of CHD. Such tools could help inform otherwise healthy individuals that their risk is increased, allowing them to make more informed decisions about their behaviours and treatment.
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Valdimarsdottir HB, Zakowski SG, Gerin W, Mamakos J, Pickering T, Bovbjerg DH. Heightened psychobiological reactivity to laboratory stressors in healthy women at familial risk for breast cancer. J Behav Med 2002; 25:51-65. [PMID: 11845558 DOI: 10.1023/a:1013589718212] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined the possibility that reactivity to acute stressors may be altered among women facing the chronic stress of being at familial risk for breast cancer. Sixteen healthy women with histories of breast cancer in their families (Risk Group) and 32 women at normal risk (Comparison Group) were exposed to 15 min of classic laboratory stressors. Seventeen women at normal risk were randomly assigned to nonstressful tasks (manipulation check). Self-reported distress, natural killer cell activity (NKCA), and NK cell numbers (percentage of CD3-CD16/56+ lymphocytes) were assessed before and after the tasks. Cardiovascular activity was assessed throughout the session. The tasks elicited increases in distress, heart rate, NKCA, and NK cells numbers in both experimental groups. Supporting study hypotheses, the Risk Group had larger increases in distress, heart rate, NKCA, and NK cell numbers. These findings raise the possibility that the chronic stress associated with familial cancer risk may have negative health consequences through changes in psychobiological reactivity.
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Affiliation(s)
- Heiddis B Valdimarsdottir
- Biobehavioral Medicine Program, Cancer Prevention and Control, Ruttenberg Cancer Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1130, New York 10029-6574, USA.
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126
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Absetz P, Aro A, Sutton S. Factors Associated with Breast Cancer Risk Perception and Psychological Distress in a Representative Sample of Middle-aged Finnish Women. ANXIETY STRESS AND COPING 2002. [DOI: 10.1080/10615800290007290] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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128
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Audrain J, Schwartz M, Herrera J, Goldman P, Bush A. Physical activity in first-degree relatives of breast cancer patients. J Behav Med 2001; 24:587-603. [PMID: 11778352 DOI: 10.1023/a:1012943411367] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study sought to evaluate physical activity in women at moderate risk for breast cancer, the correlates of engaging in regular physical activity, and whether physical activity relates to psychological well-being. The results revealed that 55% of women were regularly active. Logistic regression models indicated that positive affect was associated with increased and negative affect was associated with decreased overall and leisure activity. Older, married, and employed women were more likely to engage in household/occupational activity, whereas women who perceived their risk for breast cancer as high were less likely. More educated women and those with higher perceived risk were more likely to engage in leisure activity, and married women were less likely. These results suggest a need to increase activity levels in women at moderate risk for breast cancer, provide variables upon which interventions can be tailored to promote activity, and point to psychological benefits of activity in this population.
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Affiliation(s)
- J Audrain
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, Pennsylvania 19104-3309, USA.
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129
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Trask PC, Paterson AG, Wang C, Hayasaka S, Milliron KJ, Blumberg LR, Gonzalez R, Murray S, Merajver SD. Cancer-specific worry interference in women attending a breast and ovarian cancer risk evaluation program: impact on emotional distress and health functioning. Psychooncology 2001; 10:349-60. [PMID: 11536413 DOI: 10.1002/pon.510] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intrusive thoughts about cancer, often identified as 'cancer-specific worries' or 'cancer-specific distress', have been postulated to be associated with dysfunction in women at increased risk of developing breast or ovarian cancer. The current study discusses the development and validation of a measure designed to assess women's perceptions of the interference such worries create in their daily functioning. Analyses revealed that approximately two-thirds of a high-risk breast cancer clinic sample perceived worries about breast cancer as interfering with their functioning across a variety of life domains. Multiple regression analyses indicated that worry interference scores predicted Profile of Mood States (POMS) Anxiety and Confusion, and Short Form-36 (SF-36) Role-Emotional and Mental Health scores after the effects of other variables such as frequency of worry about breast cancer, and having a family history of cancer had been considered. Women who perceived their worries as interfering with their functioning reported higher levels of anxiety and confusion, and diminished mental health and role functioning. The results add to the expanding area of anxiety/distress in at-risk populations by providing (1) a direct measure of the perceived interference associated with breast cancer-specific thoughts, (2) a validation of the measure via its associations with standard measures of emotional distress and health functioning, and (3) evidence of the measure's incremental predictive value in explaining distress and quality of life, after consideration of background variables, such as having a family history of cancer.
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Affiliation(s)
- P C Trask
- Behavioral Medicine Program, University of Michigan, Ann Arbor, MI 48108-0757, USA.
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130
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Bluman LG, Borstelmann NA, Rimer BK, Iglehart JD, Winer EP. Knowledge, satisfaction, and perceived cancer risk among women diagnosed with ductal carcinoma in situ. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2001; 10:589-98. [PMID: 11559456 DOI: 10.1089/15246090152543175] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The prevalence of ductal carcinoma in situ (DCIS) has increased through more widespread use of screening mammography. Little is known about what women with DCIS understand about their disease and future health. Although there is a wealth of information about the psychological characteristics of women with invasive breast cancer, there is virtually no information about women who have received treatment for DCIS. Seventy-six women diagnosed with DCIS who were identified through the Duke University Tumor Registry completed a mailed self-administered questionnaire including a broad range of items to measure knowledge, satisfaction with care, risk perceptions, and psychological distress. Women with DCIS have knowledge deficits about DCIS and breast cancer, as well as concerns about recurrence and misperceptions about the likelihood for DCIS metastasis. Women were generally satisfied with their care. They were less satisfied with information related to prognosis and with perceived support from their doctors. The results of this study suggest several areas of concern for women diagnosed with DCIS. Data about risk perceptions, knowledge, and attitudes in women diagnosed with DCIS provide important preliminary ideas for future studies. In view of the frequency of the DCIS diagnosis, future investigation should be conducted to build on these findings.
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Affiliation(s)
- L G Bluman
- Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA
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131
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Rees G, Fry A, Cull A. A family history of breast cancer: women's experiences from a theoretical perspective. Soc Sci Med 2001; 52:1433-40. [PMID: 11286366 DOI: 10.1016/s0277-9536(00)00248-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Individuals at increased risk of developing breast cancer due to their family history of the disease face a number of uncertainties. Personal cancer risk estimates are imprecise and current methods for early detection or prevention are not 100% effective. It is therefore not surprising that adverse psychosocial outcomes have been described within this population. Research attempting to predict the incidence of distress and dysfunction in individuals at increased risk of cancer has been largely a-theoretical and has overlooked a number of potentially important predictive variables. In particular, the influence of personal experience of cancer through involvement with affected relatives has been neglected. There are strong theoretical grounds for hypothesising that dimensions of personal experience may influence response to cancer risk. This paper discusses the potential impact of personal experience on risk perception, illness representations and decision-making. Systematic research in this area may improve predictions of outcome of cancer genetic counselling and inform the clinical process.
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Affiliation(s)
- G Rees
- Medical Oncology Unit, Western General Hospital, Edinburgh, UK.
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132
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[Emotional, physical and social consequences of breast cancer: viability and utilization of a clinical questionnaire]. Canadian Journal of Public Health 2001. [PMID: 11257994 DOI: 10.1007/bf03404846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate the reliability of a French Canadian version of the "Psychological Consequences Questionnaire" (PCQ) among 306 Quebec women between the ages of 50 and 69. The internal consistencies of the emotional, physical and social dimensions are respectively 0.91, 0.86 and 0.72 (Cronbach's alpha). The temporal stability was greater than 68% for each question. Meanwhile, analysis showed that 4 of the 12 questions were highly predictive of the results of the whole questionnaire (R2 = 0.91). In addition, these 4 questions are in concordance with the diagnostic criteria for adaptive disorder, anxiety disorder and general anxiety. The French Canadian version of PCQ was found to be easy to use and reliable. We would suggest a shorter version of the questionnaire, including only four questions. This version would be even easier to use and more effective to control the emotional, physical and social consequences over the different stages of breast cancer screening.
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133
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Erblich J, Bovbjerg DH, Valdimarsdottir HB. Looking forward and back: distress among women at familial risk for breast cancer. Ann Behav Med 2001; 22:53-9. [PMID: 10892528 DOI: 10.1007/bf02895167] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Healthy women with family histories of breast cancer in a first-degree relative (FH+) have been reported to exhibit higher levels of breast cancer-related distress than women without family histories of breast cancer (FH-). Recent data suggest that this may be particularly true for women who had a parent die of cancer. In line with theories emphasizing the psychological impacts of past stressors and concerns for the future, the present study examined the hypotheses that past cancer stressors (i.e. maternal breast cancer caregiving and death, "Looking Back") and perceptions of one's own heightened future risk for developing the disease ("Looking Forward") would predict current levels of distress. One hundred forty-eight healthy women (57 FH+, 91 FH-) recruited from large medical centers in the New York City area completed measures of breast cancer-related distress, general psychological distress, and items assessing whether or not they had taken care of their mother with breast cancer or had had their mother die from the disease. Consistent with previous research, results indicated that FH+ women whose mothers had died of breast cancer had significantly higher breast cancer-related distress than either FH+ women whose mothers had not died of breast cancer or FH- women (p < .05). Further analyses revealed that FH+ women who had cared for their mothers with breast cancer had higher cancer-related distress than women who did not (p < .01), and that FH+ women whose experience included both caregiving and the death of their mother from breast cancer had the highest levels of cancer-related distress (p < .01) and depressive symptoms (p < .05). Findings also indicated that FH+ women with heightened perceptions of risk for breast cancer had higher levels of distress, independent of past stressors. These findings suggest that psychosocial interventions for women with family histories of breast cancer might be appropriately focused on these issues.
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Affiliation(s)
- J Erblich
- Biobehavioral Medicine Program, Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York, NY 10029-6574, USA
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134
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Broadstock M, Michie S, Gray J, Mackay J, Marteau TM. The psychological consequences of offering mutation searching in the family for those at risk of hereditary breast and ovarian cancer--a pilot study. Psychooncology 2000; 9:537-48. [PMID: 11180589 DOI: 10.1002/1099-1611(200011/12)9:6<537::aid-pon479>3.0.co;2-u] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM To describe the short and longer-term psychological consequences of waiting for the results of mutation searching (MS) amongst those at risk of hereditary breast and ovarian cancer (HBOC). DESIGN A prospective study, with measures before the offer of a mutation search, and 1 week, 6 months and 12 months afterwards. SAMPLE 21 unaffected women at risk of HBOC offered MS in an affected relative at one of two UK regional genetics centres. OUTCOME MEASURES Standardized questionnaire measures of general anxiety, general distress, distress about cancer in the family and cancer-specific worries. RESULTS Mutation searches were initiated in 15 of 21 families; two received results within 12 months. For the 13 still waiting for results, levels of anxiety and distress were within normal ranges at all time-points. They reported reduced worries about cancer 6 and 12 months post-search offer compared with earlier assessments, but experienced an increase in general anxiety 12 months since the search offer. These changes over time were not found in those not waiting for the results of a mutation search. CONCLUSION The majority of women were without a result 12 months after being offered MS. Whilst these women were less worried about cancer in the 6 months after initiating the testing process, their anxiety levels increased 12 months since the offer of a mutation search. Seeing a specialist seems to reduce cancer worries. There may, however, be long-term psychological costs of offering tests that are unlikely to give results in a foreseeable future.
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Affiliation(s)
- M Broadstock
- Cancer Research Campaign Department of Oncology, Addenbrooke's Hospital, University of Cambridge, UK
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135
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Metcalfe KA, Liede A, Hoodfar E, Scott A, Foulkes WD, Narod SA. An evaluation of needs of female BRCA1 and BRCA2 carriers undergoing genetic counselling. J Med Genet 2000; 37:866-74. [PMID: 11073541 PMCID: PMC1734476 DOI: 10.1136/jmg.37.11.866] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The discovery of the breast and ovarian cancer susceptibility genes BRCA1 and BRCA2 has improved our ability to counsel women at increased risk of developing breast and ovarian cancer. The objective of our study was to identify the needs of women who have undergone genetic counselling and testing for BRCA1/2 and to determine the impact of receiving a positive BRCA1/2 result. This is the first study to report on a large group of women who have received positive BRCA1/2 mutation results. METHODS Questionnaires were distributed to 105 women who had received pre- and post-test genetic counselling for a positive BRCA1/2 result at the University of Toronto or at McGill University in Montreal, Canada between the years of 1994 and 1998. The questionnaire items included patient motivation for seeking genetic services, information needs, screening and prophylactic surgery practices, satisfaction with access to services and support, the desire for a support group, and overall client satisfaction. RESULTS Seventy nine female carriers were surveyed. The majority of the respondents (77%) were satisfied with the information they received during the genetic counselling process. Women with a previous diagnosis of cancer indicated that they needed more information relating to cancer treatment compared to women without cancer (p=0.05). Nineteen percent of the women felt they needed more support than was received. Fifty eight percent of the women reported that their screening practices had changed since they received their result. Young women (below the age of 50) and women with no previous diagnosis of cancer were most likely to have changed their screening practices. Nearly two thirds of the respondents said they had considered prophylactic surgery of the breasts or ovaries. Twenty eight percent of the women had prophylactic mastectomy and 54% had undergone prophylactic oophorectomy. Women with an educational level of high school or more were more likely to have undergone prophylactic bilateral mastectomy than those with less education (p=0.07) but were less likely to undergo prophylactic oophorectomy (p=0.0007). CONCLUSION These findings have a direct impact on the counselling and risk management of female BRCA mutation carriers. Age, education, and a previous diagnosis of cancer are important determinants in a woman's decision making after receiving positive genetic test results.
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Affiliation(s)
- K A Metcalfe
- Centre for Research in Women's Health, University of Toronto, 790 Bay Street, Suite 750A, Toronto, Ontario M5G 1N8, Canada
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136
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Abstract
The papers by Huerta and Macario and Kreuter share the theme of suggesting new directions for risk communication research in cancer prevention and control. Huerta and Macario remind us once again that sociocultural factors must be considered when conducting risk communication research on underserved populations. Of special note is their recommendation to target the family, which could introduce a compelling new chapter in risk communication research in cancer prevention and control. In contrast, Kreuter challenges us to consider multiple cancer risks and risk-reducing behaviors in our research and provides a provocative framework for achieving this goal. Given this common theme and the need to position specific recommendations within the larger context of other competing research questions, this paper also highlights several additional recommendations for future research. These recommendations include the following: more research on risk presentation; establishing guidelines for measuring risk; additional research testing strategies to de-bias optimistic and pessimistic perceptions of risk and evaluating risk communication as a strategy for behavior change; more research investigating the sociology of risk communication, with a special emphasis on the family as the unit of investigation; and, finally, more research that specifically targets underserved populations in diverse community settings.
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Affiliation(s)
- A C Marcus
- AMC Cancer Research Center, 1600 Pierce Street, Denver, CO 80214, USA.
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137
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Brain K, Gray J, Norman P, France E, Anglim C, Barton G, Parsons E, Clarke A, Sweetland H, Tischkowitz M, Myring J, Stansfield K, Webster D, Gower-Thomas K, Daoud R, Gateley C, Monypenny I, Singhal H, Branston L, Sampson J, Roberts E, Newcombe R, Cohen D, Rogers C, Mansel R, Harper P. Randomized trial of a specialist genetic assessment service for familial breast cancer. J Natl Cancer Inst 2000; 92:1345-51. [PMID: 10944557 DOI: 10.1093/jnci/92.16.1345] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Because of the growing demand for genetic assessment, there is an urgent need for information about what services are appropriate for women with a family history of breast cancer. Our purpose was to compare the psychologic impact and costs of a multidisciplinary genetic and surgical assessment service with those of current service provisions. METHODS We carried out a prospective randomized trial of surgical consultation with (the trial group) and without (the control group) genetic assessment in 1000 women with a family history of breast cancer. All P: values are from two-sided tests. RESULTS Although statistically significantly greater improvement in knowledge about breast cancer was found in the trial group (P: =.05), differences between groups in other psychologic outcomes were not statistically significant. Women in both groups experienced statistically significant reductions in anxiety and found attending the clinics to be highly satisfying. An initial specialist genetic assessment cost pound 14.27 (U.S. $22.55) more than a consultation with a breast surgeon. Counseling and genetic testing of affected relatives, plus subsequent testing of family members of affected relatives identified as mutation carriers, raised the total extra direct and indirect costs per woman in the trial group to pound 60.98 (U.S. $96.35) over costs for the control subjects. CONCLUSIONS There may be little benefit in providing specialist genetics services to all women with a family history of breast cancer. Further investigation of factors that may mediate the impact of genetic assessment is in progress and may reveal subgroups of women who would benefit from specialist genetics services.
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Affiliation(s)
- K Brain
- Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, UK.
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138
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139
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Baider L, Ever-Hadani P, Kaplan De-Nour A. Psychological distress in healthy women with familial breast cancer: like mother, like daughter? Int J Psychiatry Med 2000; 29:411-20. [PMID: 10782424 DOI: 10.2190/ld2f-nd7r-19jk-wl4g] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In 1977, the Israel Cancer Association held a one-day conference, on the subject of familial breast cancer, for healthy women with at least one first-degree relative diagnosed with breast cancer. The objective of this study was to assess the psychological distress of a sample of the women who attended. METHOD Of the 333 healthy women present at the conference, 230 completed three questionnaires: one on sociodemographic data and the medical history of the first-degree relative(s) (mother and/or sister), and two that measure psychological distress: the Brief Symptom Inventory and the Impact of Events Scale. SAMPLE The subjects were divided into three categorical groups: those whose mother had breast cancer (group A, N = 176), those whose sister had breast cancer (group B, N = 34), and those whose mother and sister both had the disease (group C, N = 20). In addition, subjects were divided into two groups according to the psychological distress level. RESULTS Analysis of results (using ANOVA and a Chi square test for categorical variables and both univariate and multivariate procedures for psychological distress assessment) showed elevated levels of distress and persistent intrusive thoughts in all groups, and particularly in group C. CONCLUSION There is a need to promote genetic diagnostic and appropriate counseling, notwithstanding the potential risks that genetic counseling poses for such women.
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Affiliation(s)
- L Baider
- Sharett Institute of Clinical Oncology, Hadassah University Hospital, Jerusalem
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140
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Brain K, Gray J, Norman P, Parsons E, Clarke A, Rogers C, Mansel R, Harper P. Why do women attend familial breast cancer clinics? J Med Genet 2000; 37:197-202. [PMID: 10699056 PMCID: PMC1734549 DOI: 10.1136/jmg.37.3.197] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The increasing demand for genetic assessment for familial breast cancer has necessitated the development of cancer genetics services. However, little is known about the factors motivating the client population likely to approach these services. A cross sectional questionnaire survey of 1000 women with a family history of breast cancer was conducted to identify self-reported reasons for attending a familial breast cancer clinic and possible differences in the characteristics of women who were attending for diverse reasons. Before attendance at clinic, 833 women completed a baseline questionnaire (83% response rate). Women who gave personal risk (n=188), awareness of a family history (n=120), risk to family members (n=84), reassurance (n=69), genetic testing (n=65), breast screening (n=46), or prevention (n=39) as their main reason for attending were compared on demographic and medical variables, and on psychological variables including general anxiety, cancer worry, perceived risk, and attitudes towards prophylactic surgery and genetic testing. Important differences in the psychological characteristics of these groups were found, which were unrelated to reported family history. In particular, women who primarily wanted genetic testing felt extremely vulnerable to developing breast cancer, were more likely to be considering prophylactic surgery, and perceived fewer limitations of testing. Those who primarily wanted reassurance were highly anxious about the disease. We recommend that cancer genetics services take into consideration the informational and psychological needs and concerns of their client group.
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Affiliation(s)
- K Brain
- Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XN, UK
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141
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Coyne JC, Benazon NR, Gaba CG, Calzone K, Weber BL. Distress and psychiatric morbidity among women from high-risk breast and ovarian cancer families. J Consult Clin Psychol 2000. [DOI: 10.1037/0022-006x.68.5.864] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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142
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Meiser B, Butow P, Barratt A, Friedlander M, Kirk J, Gaff C, Haan E, Aittomäki K, Tucker K. Breast cancer screening uptake in women at increased risk of developing hereditary breast cancer. Breast Cancer Res Treat 2000; 59:101-11. [PMID: 10817345 DOI: 10.1023/a:1006330631832] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This multicenter study assessed breast cancer screening uptake in 461 unaffected women at increased risk of developing breast cancer on the basis of family history who approached familial cancer clinics for advice about surveillance options. At the time of attending the clinic, 89% and 90% of participants were vigilant with respect to age- and risk-specific recommendations for mammography and clinical breast examination, respectively, and 51% reported practicing breast self-examination monthly or more frequently. The degree to which health outcomes are perceived to be under one's personal control (chi2 = -2.09, p = 0.0037) and breast cancer anxiety (chi2 = 8.11, p = 0.044) were both associated with monthly or more frequent breast self-examination, while there were no associations with sociodemographic characteristics. A significantly lower percentage (56%) of women aged <30 were vigilant with respect to mammography recommendations, compared to 77%, 96% and 98% of women aged 30-39, 40-49 and >50, respectively (chi2 = 37.2, p < 0.0001). These relatively low rates of mammographic screening in young women may reflect concerns about increased cancer risk associated with early and repeated radiation exposure or lack of sensitivity in young women with radiographically dense breasts. If mammographic screening is ultimately shown to lower mortality in women at high risk, there will be a strong case to promote screening in young women. The need for regular mammographic screening would then need to be highlighted and reinforced amongst young women and their referring physicians. Awareness amongst general practitioners, who are largely responsible for referral to screening services, would also need to be increased.
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Affiliation(s)
- B Meiser
- Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, NSW, Australia
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143
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Hartmann LC, Sellers TA, Schaid DJ, Nayfield S, Grant CS, Bjoraker JA, Woods J, Couch F. Clinical options for women at high risk for breast cancer. Surg Clin North Am 1999; 79:1189-206. [PMID: 10572558 DOI: 10.1016/s0039-6109(05)70068-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Women at hereditary risk of breast cancer face a difficult clinical decision. Each of the options available to them has unique advantages and disadvantages that are summarized in Table 9. Many components enter a high-risk woman's decision: her objective risk of breast cancer; clinical features, such as the consistency of breast tissue and resultant ease of examination; breast density on mammography; personal characteristics, including her experience with cancer within her family; her role and [table: see text] responsibilities within her own nuclear family; her values and goals; her experiences with the medical system; and her subjective assessment of risk. It is generally believed that women significantly overestimate their risk of breast cancer. Thus, it is vital that a woman at risk have access to a genetic counselor who can provide accurate assessment of her risk. Women should be encouraged to take time to understand their risk level and the advantages and disadvantages of the options before them.
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144
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Abstract
Genetics plays a role in every disease, yet few health care providers understand basic genetic principles or the science underlying the genetic testing process. An understanding of the science behind genetic advances is necessary, and it is equally important for health professionals to have an understanding of the complex nature of genetic testing for individuals and their families. Much of the debate about the psychological effects of genetic testing has occurred in the absence of empirical data on diseases for which predictive testing has only recently emerged. This article will review selected literature on genetic testing and its implications for the individual and the family. The responses of families and individuals to the diagnosis of a genetic disease will be reviewed, and Huntington disease will be used as the paradigm for examining issues related to genetic testing for adult-onset cancers. Literature addressing the response to genetic susceptibility for adult-onset cancers and the implications of testing children also will be explored. Finally, identification of emerging issues relevant to genetic screening will provide a framework for identifying needed nursing research in genetic testing for adult-onset cancer risk.
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Affiliation(s)
- L A Jacobs
- University of Pennsylvania, Philadelphia, USA
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145
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Lesniak KT, Callaway TG, Althaus B, Guarnaccia CA, Blum JL. Psychological and Behavioral Implications of Screening for Breast or Ovarian Cancer Predisposition Genes BRCA1 and BRCA2. Proc (Bayl Univ Med Cent) 1999. [DOI: 10.1080/08998280.1999.11930150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | | | - Becky Althaus
- Baylor-Charles A. Sammons Cancer Center, BUMC, Dallas, Texas
| | | | - Joanne L. Blum
- Baylor-Charles A. Sammons Cancer Center, BUMC, Dallas, Texas
- Texas Oncology, PA, and PRN Research, Inc., Dallas, Texas
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146
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Abstract
Genetic testing for inherited forms of breast cancer is currently available to individuals who want to learn their genetic status for the BRCA1 and BRCA2 genes. Although still largely limited to research programs, widespread commercial testing and incorporation of genetic testing into primary care practices will occur in the not too distant future. Despite the availability of this technology, treatment and prevention strategies offered to these often healthy women are limited and somewhat controversial. Due to the medical and emotional complexities associated with the gap between genetic information and treatment interventions, behavioral scientists are currently investigating the psychosocial implications involved in genetic testing for the BRCA1/2 genes. This article attempts to summarize the current research models, and reviews the most recent findings of investigations evaluating the emotional and behavioral implications associated with genetic testing for breast cancer susceptibility.
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Affiliation(s)
- C L Carter
- Department of Psychology, University of Southern Mississippi, Hattiesburg 39406-9371, USA
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147
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Schwartz MD, Rimer BK, Daly M, Sands C, Lerman C. A randomized trial of breast cancer risk counseling: the impact on self-reported mammography use. Am J Public Health 1999; 89:924-6. [PMID: 10358689 PMCID: PMC1508646 DOI: 10.2105/ajph.89.6.924] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We evaluated the impact of individualized breast cancer risk counseling on mammography use among women at risk for breast cancer. METHODS Participants (n = 508) were randomized to the breast cancer risk counseling intervention or a general health education control intervention, and 85% completed follow-up. RESULTS In multivariate modeling, a significant group-by-education interaction demonstrated that among less-educated participants, breast cancer risk counseling led to reduced mammography use. There was no intervention effect among the more-educated participants. CONCLUSIONS These results suggest that standard breast cancer risk counseling could have an adverse impact on the health behaviors of less-educated women.
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Affiliation(s)
- M D Schwartz
- Georgetown University Medical Center/Lombardi Cancer Center, Cancer Genetics, Washington, DC 20007, USA.
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148
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Taylor KL, DiPlacido J, Redd WH, Faccenda K, Greer L, Perlmutter A. Demographics, family histories, and psychological characteristics of prostate carcinoma screening participants. Cancer 1999; 85:1305-12. [PMID: 10189136 DOI: 10.1002/(sici)1097-0142(19990315)85:6<1305::aid-cncr13>3.0.co;2-i] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The goals of this study were to 1) understand the reasons that men seek prostate carcinoma screening, in light of the ongoing medical controversy surrounding screening; and 2) assess the level of psychological distress and perceived risk among men seeking screening, and whether or not these variables were dependent on a man's family history of prostate carcinoma. METHODS The subjects were 126 men (40% had a family history of prostate carcinoma) who participated in a free prostate carcinoma detection program. Questionnaires, which were completed prior to prostate carcinoma screening, included demographic and medical information, reasons for screening participation, general and cancer-related psychological distress, and perceived risk for prostate carcinoma. RESULTS Among both family history groups, self-referral was the most common reason for attending the screening, compared with receiving a recommendation from a health professional or from a friend or family member. Men with a positive family history were not more distressed than those without a family history; but as the authors predicted, men with a positive family history of prostate carcinoma did report higher levels of perceived risk relative to those without a family history. In addition, an interaction revealed that psychological distress was greater among men with a family history only among those who also reported elevated perceived risk. CONCLUSIONS Similar to other prostate carcinoma screening programs, men in the current sample largely elected to attend the screening on their own. Furthermore, although perceived risk was higher among men with a family history compared with those without a family history, psychological distress was greater among men with a family history only among those who also reported elevated perceived risk. Thus, among men with a family history of the disease, perceived risk may be a marker of elevated psychological distress. Screening programs should assess family history and perceived risk because of the potential psychological implications for screening participants.
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Affiliation(s)
- K L Taylor
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC 20007, USA
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149
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Brain K, Norman P, Gray J, Mansel R. Anxiety and adherence to breast self-examination in women with a family history of breast cancer. Psychosom Med 1999; 61:181-7. [PMID: 10204971 DOI: 10.1097/00006842-199903000-00010] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous research has indicated low rates of adherence to monthly breast self-examination (BSE) in women with a family history of breast cancer, and anxiety has been identified as a major factor that may interfere with regular self-examination. However, the direction of the relationship between anxiety and BSE frequency remains unclear, with some studies indicating that high anxiety promotes adherence and others indicating that it leads to avoidance. The aim of the present study was to clarify the relationship between anxiety and adherence to breast self-examination by comparing the impact of general anxiety with that of cancer-specific anxiety on BSE frequency. METHODS A sample of at-risk women (N=833) completed a questionnaire regarding BSE frequency, general anxiety, breast cancer worries, perceived risk of breast cancer, and family history of breast cancer. Women who self-examined infrequently (N=211), appropriately (N=462), or excessively (N=156) were compared on these variables. RESULTS Statistical analyses indicated that general anxiety differentiated only between excessive self-examiners and less frequent self-examiners, with excessive self-examiners reporting significantly higher general anxiety. Breast cancer worries differentiated between all three groups in a linear fashion, with increasing cancer worries associated with higher levels of BSE. CONCLUSIONS In some at-risk women, high cancer anxiety may lead to high general anxiety and precipitate hypervigilant breast self-examination rather than avoidance. These findings are discussed in relation to psychoeducational interventions and genetic counseling services for women with a family history of breast cancer.
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Affiliation(s)
- K Brain
- Institute of Medical Genetics, University of Wales College of Medicine, Cardiff, United Kingdom.
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150
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Marcus AC, Ahnen D, Cutter G, Calonge N, Russell S, Sedlacek SM, Wood M, Manchester D, Fox L, McCaskill-Stevens W, Fairclough D, Hines S, Wenzel L, Osborn K. Promoting cancer screening among the first-degree relatives of breast and colorectal cancer patients: the design of two randomized trials. Prev Med 1999; 28:229-42. [PMID: 10072740 DOI: 10.1006/pmed.1998.0408] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In this paper two large nationwide trials are described, both of which will test a comparable telephone-based counseling intervention to promote cancer screening among the first-degree relatives (FDRs) of breast and colorectal cancer patients. The unit of randomization will be the family unit of eligible FDRs. Access to FDRs will be obtained from their relatives with cancer. Selected intervention and design issues are reviewed, including how both projects will respond to FDRs who exhibit significant levels of cancer-specific anxiety or distress and how potential high-risk cancer families will be accommodated. METHODS Pursuant to the development of both studies, two feasibility surveys were conducted to determine whether patients would grant access to their FDRs and whether the FDRS identified by these patients would be receptive to the telephone intervention. RESULTS Approximately 80% (106 of 132) of breast cancer patients agreed to provide access to their eligible FDRs when contacted on-site at participating hospitals and clinics. Of those subsequently selected for telephone follow-up (n = 95 or 90%), 80% (n = 76) were successfully contacted by telephone, and of these 97% (n = 74) provided the names and telephone numbers of their FDRs. Among colorectal cancer patients contacted on-site (n = 46), 96% (n = 44) agreed to provide access to their FDRs, and of those contacted by telephone (n = 33 or 75%), 91% (n = 30) provided the requested information about their FDRs. Once contacted, 95% of breast cancer FDRs (55 of 58) and 91% of colorectal cancer patients (51 of 56) endorsed the intervention strategy. CONCLUSIONS It is argued that this intervention, if proven effective, could provide an exportable strategy for reaching large numbers of high-risk individuals to promote cancer screening.
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Affiliation(s)
- A C Marcus
- AMC Cancer Research Center, 1600 Pierce Street, Denver, Colorado, 80214, USA
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