Psychological distress and surveillance behaviors of women with a family history of breast cancer

The role of cancer worry in cancer screening: a theoretical and empirical review of the literature

This paper reviews findings regarding the influence of cancer worry on cancer screening behaviors. The role of cancer worry in motivating cancer screening has been pursued for over 30 years. Recent concerns that high levels of cancer worry may impede the screening behavior of high-risk individuals have further prioritized this area of research. Despite heavy attention in the literature, there is currently no theoretical or empirical consensus concerning whether cancer worry motivates or inhibits cancer screening behaviors. We focus the review on four questions: (1) What is cancer worry? (2) To what extent are people worried about cancer? (3) What are the predominant theoretical approaches to understanding the role of cancer worry in cancer screening behaviors? (4) What is the empirical evidence for the role of cancer worry in cancer screening behaviors? We identify factors that have hampered theoretical and empirical advancement, including divergent definitions and measurement strategies for cancer worry, low to moderate levels of cancer worry even among those at high risk, and a reliance on cross-sectional research designs. The review clarifies the current state of this literature, and proposes future research strategies, including an expanded emphasis on cancer worry and cancer screening among men and diverse racial/ethnic groups.

To Test or Not To Test? Moderators of the Relationship Between Risk Perceptions and Interest in Predictive Genetic Testing

The moderating effects of motivational factors (illness prevention vs. emotional reassurance), regulatory focus (health vs. illness orientations), and cancer anxiety on the relationship between risk perceptions and women's interest in predictive genetic testing for breast cancer were studied among 102 women with no history of breast cancer. Risk perceptions per se were unrelated to testing interests. Perceptions of higher personal risk for developing breast cancer were positively related to women's interest in testing only among women whose dominant motivation was not emotional reassurance, who were not oriented towards ruling-out disease, and who were not highly anxious about breast cancer. These findings pointed to conditions under which risk perceptions may enhance screening behaviors, and other conditions under which they may not.

Posttraumatic stress associated with cancer history and BRCA1/2 genetic testing

OBJECTIVE

A subset of women who are at elevated cancer risk due to family history exhibit evidence of cancer-specific distress. These stress responses may represent symptoms of posttraumatic stress disorder (PTSD). The present study assessed rates of PTSD related to personal or family cancer history and BRCA1/2 testing.

METHODS

Participants were 84 women enrolled in a larger project focused on genetic testing decisions. Semistructured diagnostic interviews were used to identify instances of threshold and subthreshold PTSD.

RESULTS

Results indicated that 16.7% of the women reported current threshold or subthreshold PTSD related to personal or family cancer history. An additional 26.2% reported past-only cancer-related threshold or subthreshold PTSD. Of the 65 women who received BRCA1/2 results and completed the test-related PTSD module, only 7.7% reported threshold or subthreshold PTSD related to the genetic testing process. However, when rates were examined based on carrier status, 25.0% of BRCA1/2 carriers reported test-related threshold or subthreshold PTSD compared with only 10.0% of variants and 2.3% of noncarriers.

CONCLUSIONS

Results from this study suggest that both personal and family cancer diagnoses can be significant stressors for a subset of high-risk women. Rates of threshold and subthreshold PTSD related to genetic testing appear to be less common, although carriers may be at higher risk for significant posttraumatic symptoms.

Portrayal of genetic risk for breast cancer in ethnic and non-ethnic newspapers

There has been enormous attention paid to the genetics of breast cancer in this era of genomic medicine. A great deal of the interest has been generated through discourse in the public mass media. However, genetic risk is a probabilistic concept and one that requires adequate numeracy skills. The purpose of this qualitative content analysis was to describe and evaluate the portrayal of genetic risk for breast cancer in mass print media. Mass print newspapers targeting high (Ashkenazi Jews) and low (general Canadian population) genetic risk audiences and published at least monthly, available in English and accessible through public archives at the National Library of Canada, were identified and hand searched for articles on breast cancer. Approximately 47% of breast cancer articles in 6 Jewish newspapers and published between 1996-2000 identified genetics in the title, first or last paragraph compared with 17% of 145 articles in 6 provincial newspapers published in 2000. The description of breast cancer risk was equally problematic in print media targeting high and low risk audiences. Statistics were presented in complex and contradictory ways, with, for example, the confounding of individual and population based risk estimates. Inconsistent messages about the value of genetic screening for breast cancer characterized articles in both ethnic and non-ethnic newspapers. Deciphering the information into a comprehensible form is likely challenging, particularly in light of widespread numeric-literacy limitations. The publication of discrepant research findings and the perplexing statistical information consequently brought into question the credibility of the scientific process and the recommendations of health care professionals.

Ethnicity, genetics, and breast cancer: media portrayal of disease identities

OBJECTIVE

To describe, compare, and analyze how the risk of breast cancer is framed in newspapers directed towards an ethnic minority population (Jewish) with higher risk of inherited breast cancer compared with newspaper coverage for the general population (Anglo-Canadian) without this risk.

DESIGN

This investigation utilized a mixed methods (quantitative and qualitative) approach. The design emphasized a content analysis conducted on ethnically specific and non-ethnic newspaper articles.

RESULTS

It is noteworthy that the 'Jewish' newspapers devote a substantially larger proportion of articles on breast cancer to genetic risk as the key risk factor for this disease. Articles in the Jewish newspapers tend to link being a Jewish woman with being at risk for a diagnosis of breast cancer. This ethnic 'identity' is reinforced through the repeated association of Jewish heritage and genetic breast cancer risk at the exclusion of other known risk factors. This isolated genetic link to breast cancer is not a message that is replicated within the provincial newsprint articles.

CONCLUSIONS

These findings assist in the facilitation of prevention and treatment of those with or at risk of breast cancer. The health policy implications of this portrayal as well as suggestions for change are considered.

Exploring the course of psychological distress around two successive control visits in women at hereditary risk of breast cancer

In this article we determined the course of psychological distress during a breast cancer surveillance program in women at increased risk of developing hereditary breast cancer (BC). The sample comprised of 357 unaffected women (mean age 40.5 years) adhering to a surveillance programme (MRISC-study). Before and after two successive biannual surveillance appointments, the Impact of Event Scale (BC-specific distress) and the Hospital Anxiety and Depression Scale (general distress) were administered, totalling four measurement moments. In general, psychological distress remained within normal limits and decreased significantly after a surveillance appointment, except for breast cancer specific distress after the second appointment. Scheduled imaging examinations were not significantly related to distress. The course of BC specific distress differed significantly for risk over-estimators and for young (<40 years) excessive breast self examiners. The course of general distress differed significantly for women closely involved in a sister's BC-process. These more vulnerable subgroups may be in need of extra counselling and care.

Psychological morbidity in women at increased risk of developing breast cancer: a controlled study

There has been an ongoing debate in the literature on the extent to which women with a family history of breast cancer are at risk of psychological morbidity. This study compares psychological morbidity in 557 women participating in a large Australian registry of high-risk breast cancer families (kConFab) with 2 age and education matched samples, 1494 general practitioner attendees and 158 members of a twin registry. Participants completed the Somatic and Psychological Health Report (SPHERE). There were no significant differences between the three groups on psychological distress (F(2, 670) = 1.77, p = 0.17). Unsurprisingly, GP attendees reported more symptoms of somatic distress than the kConFab group (t411 = 2.89, p = 0.004); there were no differences between the twins and the kConFab group on somatic distress (t174 = 0.40, p = 0.687). Clinically significant anxiety/depression, a combination of psychological and somatic distress, therefore was significantly higher in GP attendees (28%) than the kConFab and twin samples (both 20%). These results refute the hypothesis that women with a family history of breast cancer are at greater psychological risk.

Predictors of quality of life in women with a bilateral prophylactic mastectomy

The purpose of this study was to assess the quality of life in women who had previously undergone a bilateral prophylactic mastectomy and to determine what factors predict quality of life in this population. Women in Ontario who had undergone prophylactic mastectomy between 1991 and 2000 were asked to complete several questionnaires that assessed current psychosocial functioning, including the Quality of Life Index (QLI). The mean score for the QLI was 23.34 (range 9.53-30.00). QLI scores were negatively correlated with cancer-related distress, body image difficulties, and psychological distress. Conversely, QLI scores were positively correlated with social support. Significant predictors of quality of life included psychological distress and one subscale of body image (vulnerability). Vulnerability and psychological distress are important predictors of quality of life in women who have previously undergone bilateral prophylactic mastectomy.

Coping with appraised breast cancer risk among women with family histories of breast cancer

This descriptive correlational study was based on Neuman's Systems Model and was designed to examine how women with family histories of breast cancer appraise and cope with breast cancer risk. Ninety percent of 209 women in the sample appraised their degree of breast cancer threat as moderate or high. Women with high degrees of appraised risk had low breast cancer risk scores, while women with moderate degrees of appraised risk had higher risk scores. The most common and effective coping modes used were confrontive, optimistic, and early detection behaviors. Over 75% of women either did not use evasive, emotive, palliative, and fatalistic modes of coping, or rated them as ineffective. Canonical correlation analyses revealed five different patterns of appraisal and coping behaviors and lent support to the premise that the type of coping behaviors used varies with how breast cancer risk is appraised.

Psychosocial impact of parental cancer in adulthood: A conceptual and empirical review

This article reviews recent literature on the psychosocial aspects of parental cancer in adulthood. Overall, studies have shown that a sizable minority of adult children of cancer patients experience psychological distress in terms of anxiety, depression, and posttraumatic stress symptoms. Most research to date has focused on the first-degree female relatives of breast cancer patients, many of whom are daughters. Although distress reactions in this population are well documented, restrictive assumptions reflecting a vulnerability/deficit model of women limit scientific progress. In addition, the critical role of grown offspring caregivers of cancer patients deserves further investigation. Future research should examine the relations between intrapsychic and contextual factors that may influence psychological adjustment to parental cancer.

Apoio social e auto-exame das mamas no Estudo Pró-Saúde

Os autores investigaram a associação entre a freqüência relatada do auto-exame das mamas e cinco dimensões de apoio social (material, emocional, afetivo, de informação e interação social positiva) entre 2.240 funcionárias de uma universidade no Rio de Janeiro, participantes da Fase 1 de um estudo de coorte (Estudo Pró-Saúde). A coleta de informações foi feita por intermédio de um questionário autopreenchível. A realização do auto-exame das mamas "todo mês" ou "quase todo mês" foi relatada por 43% das funcionárias; 24% informaram praticá-lo "raramente" ou "nunca". As participantes com escores mais altos nas cinco dimensões de apoio social relataram freqüência mais elevada de auto-exame das mamas. Em todas as dimensões, a chance de praticar o auto-exame foi aproximadamente duas vezes maior entre aquelas situadas no tercil superior, e cerca de 50% mais elevada entre aquelas no tercil intermediário, quando comparadas às participantes situadas no tercil inferior dos escores de apoio social (teste para tendência linear: p < 0,001). A consistência dos resultados sugere que diversas dimensões de apoio social podem contribuir positivamente para a prática regular de autocuidados de saúde.

Psychosocial oncology: Supportive care for the cancer patient

Increasing attention is being paid to the emotional and psychosocial needs of cancer patients. As a result of huge advances in early detection and in treatment modalities, there now are millions of cancer survivors in the United States. There has been a realization that cancer survivors have distinct psychosocial needs. As cancer survivors live longer, reduction of psychological distress has been recognized as being an important part of having an improved quality of life. There have been numerous changes in the field of psychosocial oncology since it first began 25 years ago. Guidelines now exist for the definition of distress and decision trees are available for making the appropriate referrals. Advances in pharmacologic treatment for depression and anxiety have made it possible to decrease distress and increase coping in cancer patients undergoing treatment as well as in cancer survivors. Numerous individual and group therapies have demonstrated effectiveness in improving mood and quality of life in cancer patients and those at high risk for developing cancer. Due to the forthright efforts of cancer patients, there are now many organizations and list serves (e-mailing lists) that cancer survivors can turn to for help before, during, and after cancer treatment. Finally, with the rapid expansion of the internet not only are there websites available as resources, but also the creation of interactive online support is becoming a reality. One of the most important issues in providing supportive care to cancer patients in the future is to meet the individual needs of patients and provide the type of psychological therapy that will work best for them.

The impact of having relatives affected with breast cancer on psychological distress in women at increased risk for hereditary breast cancer

PURPOSE

Being at hereditary risk of breast cancer (BC) may lead to elevated levels of distress because of the impact of the BC-process in relatives.

OBJECTIVE

Determine the association between psychological distress and BC in relatives. We studied: kind of kinship with the affected relative(s), degree of involvement with the relative's BC, time elapsed since the BC diagnosis of the relative, and loss of a relative as a consequence of BC.

METHODS

The study cohort consisted of women at increased risk of developing BC, adhering to regular surveillance and participating in the Dutch MRISC-study. Two months prior to the surveillance appointment, demographics, general and BC specific distress and experience with BC in the family were assessed.

RESULTS

347 out of 351 participants (mean age 40 1/2) had at least one relative affected with BC. The following variables were significantly, positively related to BC specific distress: having at least one affected sister (n = 105; p < 0.04); close involvement in a sister's BC process (n = 94; p < 0.03); and a recent (less than three years ago) BC diagnosis in a sister (n = 30; p < 0.03). General distress did not show any significant associations with the experience of BC in the family.

CONCLUSION

These findings show the impact of a BC diagnosis in a sister, particularly a recent diagnosis, on psychological distress. Women who have experienced BC in their sister may be in need of additional counselling or of more attention during the surveillance process.

The psychotherapy of genetics

The evolution of genomic science and its effect on medicine and health care offer opportunities for family therapists to participate in the comprehensive care of patients and families with genetic disorders. This article provides an overview of what we now know about the psychological and interpersonal experience of patients and families facing some of these illnesses. Case examples illustrate the process of decision-making about testing and treatment, and the importance of understanding developmental issues and transgenerational family dynamics in any related psychotherapy. Challenging emotional issues include managing anger, ambivalence, and guilt; challenging interpersonal issues include dealing with differing coping and communication styles, decisions about disclosure and secrets, and conflict resolution. Family-oriented interventions include individual, couple, and family therapy, and psychoeducational groups. Recommendations are made for family therapists to participate as part of the genetic healthcare team.

Development and validation of a Breast Cancer Genetic Counseling Knowledge Questionnaire

Women who undergo genetic counseling concerning their increased risk of developing breast cancer confront large quantities of complex information in a short period of time. Clinical reports have suggested that many women may not retain what they learned during counseling. A validated questionnaire to measure their knowledge, however, is lacking. In this study, we describe the development and validation of a questionnaire to assess knowledge of information typically included in genetic counseling for breast cancer. Items were empirically derived from detailed content analyses of actual genetic counseling sessions. The instrument's content validity was high, as evidenced by high levels of independent interrater agreement (0.93) on items. Subsequent data reduction and confirmatory factor analytic techniques yielded a highly reliable (alpha = 0.92) 27-item Breast Cancer Genetic Counseling Knowledge Questionnaire (BGKQ). Direct comparison of this questionnaire to a scale previously developed in the literature (BCHK; [Breast Cancer Res. Treat. 53 (1999) 69]) supported the utility of the new questionnaire for evaluation of knowledge after counseling. Compared to non-counseled groups (n = 45), women who had undergone genetic counseling (n = 28) scored significantly higher (P < 0.0001) on the BGKQ, but not on the other questionnaire, establishing the BGKQ's criterion validity. The BGKQ may, thus, provide a useful clinical and research tool for assessing knowledge of information provided during genetic counseling and exploring the potential impact of distress on knowledge, as well as the impact of knowledge on screening behaviors.

The Effect of Experiential Knowledge on Construction of Risk Perception in Hereditary Breast/Ovarian Cancer

The purpose of this study was to explore the connection between experiential knowledge of hereditary breast/ovarian cancer and understandings of personal cancer risk. Using a qualitative research design, the investigator conducted in-depth interviews with 53 individuals (45 female, 8 male) from families at high-risk for hereditary breast/ovarian cancer. Study results showed that two forms of experiential knowledge, empathetic and embodied knowledge, were integral to participants' constructions of their cancer risk. They also illustrated that knowledge derived from experience often took precedence over objective clinical estimates of risk. The paper discusses the clinical implications of these findings and suggests that counseling strategies, which expand upon patient's lived experience and knowledge of the disease, may enhance communication of genetic risk. Assessment of experiential knowledge promises to suggest new ways to frame genetic information that will enable people to better understand their objective risk or to modify exaggerated and/or inaccurate risk perceptions.

The psychological impact of mammographic screening on women with a family history of breast cancer—a systematic review

This systematic review aims to assess the psychological impact of mammographic screening on women with a family history of breast cancer. Women with a family history, and hence increased risk, of breast cancer are known to experience higher levels of anxiety about cancer. They are also often offered screening from an earlier age. The psychological consequences of screening are therefore of particular importance for this group of women. A comprehensive search of 4 electronic databases was conducted from 1982 to 2003, combining sets of terms relating to (1) breast screening or mammography (breast screen*; mammogra*), (2) psychological impact (adverse effects; anxi*; distress; nervous; psych*, psychological consequences; stress; worry) and (3) family history. Reference lists from relevant papers were examined for additional papers. The review identified seven papers from four countries. Overall, the findings indicate that, similar to women in the general population, most women with a family history do not appear to experience high levels of anxiety associated with mammographic screening. Although women who are recalled for further tests do experience increased anxiety the levels appear to be no greater than for women without a family history. We conclude that further research on this topic is required--this should include studies designed specifically to consider both the negative and positive impact of mammographic screening on women with a family history, using validated measures of anxiety and worry in combination with qualitative research.

Mothers with breast cancer and their adult daughters: the relationship between mothers' reaction to breast cancer and their daughters' emotional and neuroimmune status

OBJECTIVES

The objectives of this study were to assess the associations between psychologic distress of patients with breast cancer and of their adult daughters; and to assess the associations between mothers' psychologic distress and daughters' psychologic distress, stress hormone levels, natural cytotoxic activity (NCA), and Th1 cytokine secretion.

METHODS

Eighty mothers with breast cancer and 80 adult daughters participated in the study. They completed the Symptom Check List (SCL-90R) questionnaire. In addition, daughters completed a set of questions on their health status and habits and on the effects of their mothers' disease on their own lives. Thirty milliliters of heparinized venous blood and a first early-morning urine sample were collected from daughters between 8:00 and 9:00 am. Spontaneous and interleukin-2 (IL-2)-induced NCA, in vitro IL-2 and IL-12 secretion, and levels of plasma cortisol and urinary catecholamines were tested in daughters. Forty-seven healthy women, age- and education- matched to daughters, completed the psychologic, immunologic, and hormonal tests, and served as a control group.

RESULTS

Psychologic distress of mothers and daughters was highly correlated. However, mothers experienced a higher level of distress than daughters. Mothers with advanced disease and their daughters were more distressed than mothers with primary disease and their daughters. Daughters' distress was also related to their subjective caregiving burden and the frequency of meetings with mothers. Higher distressed daughters had lower IL-2-induced NCA and decreased in vitro IL-2 and IL-12 secretion. Norepinephrine secretion level mediated the relationship between daughters' level of distress and their immune functions. Cortisol mediated only the relationship between daughters' distress and IL-2 secretion.

CONCLUSIONS

This initial study shows that the psychologic distress of mothers with breast cancer and that of their adult daughters are similar. Stress hormone secretions and immune functions of daughters are related to both their own and their mothers' psychologic distress.

Breast and colorectal cancer screening among low-income women with psychiatric disorders

This study investigated breast and colorectal cancer screening among 196 low-income women being treated for psychiatric illnesses. Main outcome measures included breast self-examination (BSE), clinical breast examination (CBE), mammography, digital rectal examination (DRE), and fecal occult blood test (FOBT). Results indicated that 49% and 66% of women 40 years of age or older had obtained mammograms and CBEs, respectively, in the preceding year. Forty-four per cent of women 20 years of age or older reported monthly BSE. Forty-six per cent and 35% of women 50 years of age or older reported having digital rectal exams (DRE) or fecal occult blood tests (FOBT), respectively, in the preceding year. Multivariate analyses showed that physician recommendation of screening was the strongest predictor of having obtained a mammogram, CBE, DRE or FOBT in the preceding year. Physician recommendation and self-confidence in performing BSE were the strongest predictors of monthly BSE. These results highlight the importance of physician recommendation of adherence to screening guidelines for breast and colorectal cancer. Because psychiatrists frequently treat psychiatric patients on a regular basis, they are in a unique position to encourage cancer screening and to monitor compliance with their recommendations.

Psychosocial impact of breast/ovarian (BRCA1/2) cancer-predictive genetic testing in a UK multi-centre clinical cohort

This multi-centre UK study assesses the impact of predictive testing for breast and ovarian cancer predisposition genes (BRCA1/2) in the clinical context. In the year following predictive testing, 261 adults (59 male) from nine UK genetics centres participated; 91 gene mutation carriers and 170 noncarriers. Self-report questionnaires were completed at baseline (pre-genetic testing) and 1, 4 and 12 months following the genetic test result. Men were assessed for general mental health (by general health questionnaire (GHQ)) and women for general mental health, cancer-related worry, intrusive and avoidant thoughts, perception of risk and risk management behaviour. Main comparisons were between female carriers and noncarriers on all measures and men and women for general mental health. Female noncarriers benefited psychologically, with significant reductions in cancer-related worry following testing (P<0.001). However, younger female carriers (<50 years) showed a rise in cancer-related worry 1 month post-testing (P<0.05). This returned to pre-testing baseline levels 12 months later, but worry remained significantly higher than noncarriers throughout (P<0.01). There were no significant differences in GHQ scores between males and females (both carriers and noncarriers) at any time point. Female carriers engaged in significantly more risk management strategies than noncarriers in the year following testing (e.g. mammograms; 92% carriers vs 30% noncarriers). In the 12 months post-testing, 28% carriers had bilateral risk-reducing mastectomy and 31% oophorectomy. Oophorectomy was confined to older (mean 41 yrs) women who already had children. However, worry about cancer was not assuaged by surgery following genetic testing, and this requires further investigation. In all, 20% of female carriers reported insurance problems. The data show persistent worry in younger female gene carriers and confirm changes in risk management consistent with carrier status. Men were not adversely affected by genetic testing in terms of their general mental health.

Decision-Making About Tamoxifen in Women at High Risk for Breast Cancer: Clinical and Psychological Factors

Purpose

To explore the health-related and psychological factors that influence decision making about tamoxifen (Nolvadex; AstraZeneca, Waltham, MA) chemoprevention in women at increased risk for developing breast cancer.

Methods

This study involves the assessment of 129 women eligible to take tamoxifen following cancer-risk counseling. Treatment decision and decision satisfaction were measured at 2 and 4 months following counseling. Health-related factors included physician recommendation, personal and family-related health history, and concern about side effects. Psychological factors included breast cancer–related anxiety, risk perception, and depression.

Results

At 2 months’ follow-up, 44% of participants declined tamoxifen treatment. This number increased to 49% at 4 months. Personal and family health history were not related to the decision, but history of abnormal biopsy did predict tamoxifen use. Physician recommendation was highly correlated with treatment decision. Concern about side effects was related to the decision to decline treatment. Breast cancer–related anxiety and heightened risk perception were associated with the decision to take tamoxifen. However, anxiety and psychological distress were also negatively related to treatment satisfaction.

Conclusion

Decision-making about tamoxifen is complex, and many eligible women decline treatment or remain undecided. Findings call for further educational follow-up with high-risk women after they undergo initial counseling. Factors related to misperceptions of risk and side effects, as well as psychological distress, may be particularly important targets for intervention.

Social constraints and distress among women at familial risk for breast cancer

BACKGROUND

Despite literature finding support for the social cognitive processing model, which suggests that social constraints are related to distress, few studies have examined possible mediators of this effect; none have examined this relation among women with family histories of breast cancer (FH+).

PURPOSE

This study was designed to examine possible effects of social constraints on psychological distress among FH+ women.

METHODS

Six FH+ women (M age = 39.2 years) completed self-report measures of social constraints, avoidance, and general and cancer-specific distress.

RESULTS

Multiple regression analyses revealed that social constraints were significantly related to both cancer-specific and general distress and that avoidance partially mediated the relation between social constraints and both types of distress.

CONCLUSIONS

Theoretical and clinical implications of these findings are discussed.

Evaluation of psychosocial effects of pre-symptomatic testing for breast/ovarian and colon cancer pre-disposing genes: a 12-month follow-up

A prospective study of psychosocial consequences following predictive testing for inherited mutations in breast/ovarian and colon cancer susceptibility genes BRCA1, BRCA2, MLH1, and MSH2 was performed. Eighty-seven healthy women were tested for known family mutations and self-assessment scales were used to evaluate anxiety, depression and quality of life. Extensive pre- and post-test information was given. Questionnaires were responded before testing and four times after during the following year. A statistically significant decrease in anxiety mean scores over time was observed among the studied participants. The levels of depression in cancer genes carriers decreased over time while, surprisingly the levels in non-carriers increased. Compared to a normative Swedish sample all women tested showed similar levels of anxiety but women tested for breast cancer genes showed statistically lower levels of depression. Vitality dropped initially after disclosure of the testing of colon cancer genes carriers, followed by increasing levels. No change in vitality or in other quality of life parameters was seen in the other groups and the levels were similar to Swedish norm data. Most tested individuals were satisfied with the testing procedure including genetic counselling and testing and all of them but one would redo the testing. Healthy self-referred women going through predictive breast/ovarian or colon cancer gene testing, including extensive pre- and post-test information and support, in general, will not experience adverse psychological consequences.

Non-uptake of predictive genetic testing for BRCA1/2 among relatives of known carriers: attributes, cancer worry, and barriers to testing in a multicenter clinical cohort

BRCA1/2 test decliners/deferrers have received almost no attention in the literature and this is the first study of this population in the United Kingdom. The aim of this multicenter study is to examine the attributes of a group of individuals offered predictive genetic testing for breast/ovarian cancer predisposition who did not wish to proceed with testing at the time of entry into this study. This forms part of a larger study involving 9 U.K. centers investigating the psychosocial impact of predictive genetic testing for BRCA1/2. Cancer worry and reasons for declining or deferring BRCA1/2 predictive genetic testing were evaluated by questionnaire following genetic counseling. A total of 34 individuals declined the offer of predictive genetic testing. Compared to the national cohort of test acceptors, test decliners are significantly younger. Female test decliners have lower levels of cancer worry than female test acceptors. Barriers to testing include apprehension about the result, traveling to the genetics clinic, and taking time away from work/family. Women are more likely than men to worry about receiving less screening if found not to be a carrier. The findings do not indicate that healthy BRCA1/2 test decliners are a more vulnerable group in terms of cancer worry. However, barriers to testing need to be discussed in genetic counseling.

Women's Approaches to the Use of New Technology for Cancer Risk Information

BACKGROUND

Women are currently offered multiple sources of breast cancer risk information, and the Internet is the most rapidly growing health information source. The objectives of this study were to identify women's preferences for receiving online breast cancer risk information, to identify barriers to accessing this information, and to identify differences in these factors between Internet users and non-users.

METHODS

Eight focus groups were conducted with women aged 18 to 74 (n = 65) living in King County, Washington.

RESULTS

Participants were interested in accessing online health information with the support of a real person to assist with information searches and in accessing personalized information online. Participants emphasized the importance of trust, both in the content provider and in the organization collecting their personal data.

CONCLUSIONS

Web sites should provide personalized information and personal searching assistance. They should also include disclosures of content sources and a privacy policy that details how personal data is handled.

Genetic testing for Alpha1-antitrypsin deficiency

PURPOSE

The Alpha Coded Testing Study investigated the risks, benefits, and psychological impact of home genetic testing for alpha1-antitrypsin deficiency.

METHODS

In the study, 996 adult individuals requested and returned a home-administered, confidential, fingerstick blood test.

RESULTS

Individuals highly rated the benefits of establishing a diagnosis (82%), helping family members (86%), and anticipating peace of mind (79%). 78% of 239 current smokers reported a high likelihood of smoking cessation if diagnosed with AATD. After testing, more than 60% indicated that they would share the results with family and physicians but < 30% would share results with insurance companies.

CONCLUSIONS

Confidential home testing for genetic disorders requires a comprehensive program of participant support.

Health behavior change among women with recent familial diagnosis of breast cancer

BACKGROUND

Although first-degree female relatives (FDFR) of women with breast cancer are at increased risk for the disease, little is understood about how familial diagnosis impacts health behaviors and what personal factors predict such changes.

METHODS

Six hundred women, ages 18 and over with a FDFR recently diagnosed with breast cancer, were interviewed after the diagnosis and again in 6 months. Participants self-reported changes in physical activity, fruit and vegetable consumption, fat consumption, alcohol and tobacco use. The effect of baseline demographics, health status, perceptions of relative's disease severity, personal risk, control over the disease and the effect of lifestyle behaviors on risk was assessed in relation to behavior changes.

RESULTS

Forty-two percent reported improving one or more behaviors. Perception that the behavior was a risk factor for breast cancer was positively associated with change for all behaviors except smoking. Poor health status, obesity and perception of control over breast cancer were associated with improvements in physical activity, fruit and vegetable consumption and fat consumption.

CONCLUSIONS

Diagnosis of breast cancer in a first-degree relative can provide motivation to improve health behavior. Educational interventions highlighting the importance of these behaviors in reducing breast cancer risk and promoting health in general may be effective in this population.

Sun protection and skin surveillance practices among relatives of patients with malignant melanoma: prevalence and predictors

BACKGROUND

Little is known about acceptance of skin cancer risk-reduction practices and attitudes among individuals with a family history of melanoma. The purpose of this study was to examine engagement in and correlates of sun protection, total cutaneous examination (TCE), and skin self-examination (SSE) among first-degree relatives (FDR) of individuals diagnosed with malignant melanoma (MM).

METHOD

First degree relatives (N = 229) completed measures of engagement in TCE, SSE, and habitual sun protection, as well as measures of knowledge and attitudes about all three behaviors.

RESULTS

Slightly more than 50% of family members reported having TCE, and engagement in habitual sun protection was relatively low. Engagement in SSE was higher. Regression analyses revealed that physician recommendation and perceived barriers were consistent correlates of all three risk-reduction behaviors. Self-efficacy and normative influences were also associated with sun protection.

CONCLUSIONS

Engagement in skin cancer risk-reduction practices among individuals with a family history of melanoma is relatively low. Interventions to improve acceptance would benefit from targeting both nonpsychological and psychological factors, particularly physician influence and perceived barriers.

Adherence to an annual PSA screening program over 3 years for brothers and sons of men with prostate cancer

OBJECTIVE

To assess the adherence to an annual PSA screening program conducted over 3 years in first-degree relatives of a sample of men with prostate cancer, and to identify characteristics of men who failed to undergo the full screening process.

PATIENTS AND METHODS

Out of 747 candidates that were eligible for the screening program (asymptomatic brothers and sons aged between 40 and 70 years of men diagnosed with prostate cancer) 640 were contacted. The screening program entailed annual serum PSA testing over a 3-year period, during which every candidates attendance was recorded. At the outset, each candidate was requested to complete a questionnaire regarding their socio-professional characteristics, their level of anxiety and their attitude towards genetic susceptibility.

RESULTS

442 (69%) candidates agreed to enter the study and 420 filled out the questionnaire. During the 3-year period, 50 candidates (12%) who had accepted the first year screening refused to undergo subsequent PSA tests. These men were younger ( p=0.015), more anxious (p=0.037 ) and to have more than one affected first-degree relative ( p=0.028 ).

CONCLUSIONS

The crucial and challenging step in the adherence to a screening program was the initial recruitment. Once recruited, adherence rate after 3 years was very high (88%). Identifying factors that help predict men who might leave the screening process may provide us means of improving their compliance in the future.

Impact of benign breast biopsy upon breast self-examination

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.

Development and Psychometric Testing of the Coping With Breast Cancer Threat Instrument

Women with a positive family history of breast cancer have a higher relative breast cancer risk. Research pertinent to this “at-risk” population has focused primarily on the early detection measures of breast self-exam, clinical breast exam, and mammography. Other specific primary prevention coping behaviors have received little research attention and, while there are instruments that measure general coping behaviors in the face of illness threat, there are no known instruments that measure coping behaviors specific to dealing with breast cancer threat. This study tested the psychometric properties of the Coping with Breast Cancer Threat instrument (CBCT). The CBCT was designed to measure primary prevention and early detection coping strategies used by women with family histories of breast cancer in response to their appraised breast cancer threat. The tool’s format was modeled after the Jalowiec Coping Scale (JCS) and included use and effectiveness scales. Internal consistency reliabilities and content and construct validity of the CBCT were assessed in a sample of 209 women with a family history of breast cancer. Alpha coefficients for the CBCT’s total use and effectiveness scales were .70 and .76, respectively. Principal components factor analysis with a varimax rotation revealed three conceptually relevant subcales that accounted for 52% of the variance in breast cancer threat coping behaviors. The CBCT was shown to be a reliable and valid measure of coping with breast cancer threat in a well-educated, European Amercian sample of middle-aged women.

Factors Predicting Prostate Specific Antigen Testing among First-Degree Relatives of Prostate Cancer Patients

First-degree relatives (FDRs) of prostate cancer patients are known to be at increased risk for the disease, yet relatively little is known about their screening behaviors. The current lack of consensus about the value of prostate cancer screening underscores the importance of examining why some men at increased risk participate in screening and others do not. In this study, variables from Protection Motivation Theory were used to identify predictors of prostate specific antigen (PSA) testing in this at-risk population. Toward this end, scales assessing perceived vulnerability, perceived severity, response efficacy, and self-efficacy for prostate cancer screening were administered to 82 unaffected male FDRs aged 40 and older. When recontacted approximately 14 months later, 50% of FDRs were found to have undergone PSA testing in the interim. Older age, prior prostate cancer screening, and a greater sense of personal efficacy about being able to undergo prostate cancer screening were found to be significant (P &lt; 0.05) predictors of subsequently undergoing PSA testing. These findings provide partial support for the predictive validity of Protection Motivation Theory variables and suggest the importance of considering efficacy beliefs in attempting to understand decision-making about PSA testing in at-risk individuals.

Impact of Genetic Testing for Breast–Ovarian Cancer Susceptibility

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.

Breast cancer risk counseling improves women's functioning

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.

Short-term impact of cancer prevention and screening activities on quality of life

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.

Family Environments of Women Seeking BRCA1/BRCA2 Genetic Mutation Testing: An Exploratory Analysis

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.

Communication and information-giving in high-risk breast cancer consultations: influence on patient outcomes

This longitudinal study aimed to document (i) the information-giving and patient-communication styles of clinical geneticists and genetic counsellors (consultants) in familial breast cancer clinics and (ii) assess the effect of these styles on women's knowledge, whether their expectations were met, satisfaction, risk perception and psychological status. A total of 158 women from high-risk breast cancer families completed self-report questionnaires at 2 weeks preconsultation and 4 weeks postconsultation. The consultations were audiotaped, transcribed and coded. Multivariate logistic regressions showed that discussing prophylactic mastectomy (P=0.00) and oophorectomy (P=0.01) led to women having significantly more expectations met; discussing genetic testing significantly decreased anxiety (P=0.03) and facilitating understanding significantly decreased depression (P=0.05). Receiving a summary letter of the consultation significantly lowered anxiety (P=0.01) and significantly increased the accuracy of perceived risk (P=0.02). Women whose consultant used more supportive communications experienced significantly more anxiety about breast cancer at the 4 weeks follow-up (P=0.00). These women were not significantly more anxious before genetic counselling. In conclusion, this study found that consultants vary in the amount of information they give and the way they communicate; and this variation can result in better or worse psychosocial outcomes. Greater use of supportive and counselling communications appeared to increase anxiety about breast cancer. Identifying methods to assist consultants to address emotional issues effectively may be helpful.

Identification of Traumatic Stress Reactions in Women at Increased Risk for Breast Cancer

It has been shown that the diagnosis and treatment of cancer may constitute a traumatic event that generates in patients and some of their family members traumatic reactions that are consistent with the symptom profile of posttraumatic stress disorder (PTSD). The present study was conducted to establish the degree to which women at increased familial risk for breast cancer showed such traumatic reactions and to establish which demographic or psychological variables may contribute to the experience of such traumatic reactions in at-risk individuals. Seventy-three women from the Revlon UCLA Breast Center High Risk Clinic were assessed for traumatic reactions that might be consistent with the DSM-IV criteria for PTSD. The results showed that women at increased risk for breast cancer exhibited traumatic responses similar to those reported by cancer patients. When the authors used a self-report instrument that maps onto DSM-IV criteria, 4% of the study subjects reported symptoms consistent with criteria for a potential diagnosis of PTSD, and an additional 7% of the subjects reported symptoms consistent with potentially subclinical levels of PTSD, according to DSM-IV criteria.

A randomised controlled trial of a psychoeducational intervention for women at increased risk of breast cancer

This study aimed to compare the impact of two versions of a psychoeducational written intervention on cancer worry and objective knowledge of breast cancer risk-related topics in women who had been living with an increased risk of familial breast cancer for several years. Participants were randomised to three conditions: scientific and psychosocial information pack (Group 1), scientific information pack only (Group 2) or standard care control (Group 3). They completed postal questionnaires at baseline (n=163) and 4 weeks (n=151). As predicted, there was a significant decrease in cancer worry for Group 1, but not Group 2. Objective knowledge significantly improved for both Group 1 and Group 2 as expected, but not Group 3. However, there was an unpredicted decline in cancer worry for Group 3. This study supports the value of a scientific and psychosocial information pack in providing up-to-date information related to familial risk of breast cancer for long-term attendees of a familial breast cancer clinic. Further research is warranted to determine how the information pack could be incorporated into the existing clinical service, thus providing these women with the type of ongoing psychosocial support that many familial breast cancer clinics are currently lacking.

Psychological impact of genetic counseling for familial cancer: a systematic review and meta-analysis

BACKGROUND

Identification of a genetic basis underlying certain types of cancer has led to an increase in demand for genetic counseling about individual risks of the disease. We conducted a systematic review of the literature to determine the quality and strength of evidence relating to psychological outcomes of genetic counseling for familial cancer.

METHODS

Six electronic databases were searched to identify controlled trials and prospective studies that examined the effect of genetic counseling on risk perception, knowledge, anxiety, cancer-specific worry, depression, and cancer surveillance. Twenty-one studies from 25 papers met inclusion criteria, including five controlled trials and 16 prospective studies. Analysis of each outcome was stratified by short-term (< or =1 month) and long-term (> or = 3 months) follow-up. Trial evidence was assessed with standardized differences of the means at follow-up between intervention and comparison groups, and these data were pooled by use of random-effects meta-analysis.

RESULTS

Meta-analysis of controlled trials showed that genetic counseling improved knowledge of cancer genetics (pooled short-term difference = 0.70 U, 95% confidence interval [CI] = 0.15 to 1.26 U) but did not alter the level of perceived risk (pooled short-term difference = -0.10 U, 95% CI = -0.23 to 0.04 U). Prospective studies reported improvements in the accuracy of perceived risk. No effect was observed in controlled trials on general anxiety (pooled long-term effect = 0.05 U, 95% CI = -0.21 to 0.31 U) or cancer-specific worry (pooled long-term difference = -0.14 U, 95% CI = -0.35 to 0.06 U), although several prospective studies demonstrated short-term reductions in these outcomes. Few studies examined cancer surveillance behaviors, and no studies attempted to measure informed choice.

CONCLUSIONS

Genetic counseling for familial cancer is associated with improvement in knowledge but does not have an adverse effect on affective outcomes. We urge further investigation of these findings through well-designed, well-reported, randomized controlled trials with suitable comparison groups and additional outcome measures.

Preoperative psychological reactions and quality of life among women with an increased risk of breast cancer who are considering a prophylactic mastectomy

A consecutive sample of 56 women with a familial risk for breast cancer who were considering a prophylactic mastectomy (PM) completed questionnaires preoperatively concerning risk perception, expectations with regard to surgery, anxiety and depressive symptoms (the Hospital Anxiety and Depression Scale (HAD) scale) and quality of life (The Swedish SF-36 Health Survey). 16 had had a previous breast cancer (Group BC) and 40 had not (Group R). They were compared with normative data from an age-matched random sample of the Swedish population and with a reference sample of women with breast cancer. Most women estimated their breast cancer risk accurately. No statistically significant differences were found between Group BC and the normative sample on the HAD scale and SF-36, but Group R reported better physical functioning, emotional role functioning and mental health than the reference sample with breast cancer. Group BC scored closer to them than to the normative sample. Levels of emotional problems and quality of life were comparable to normative values among women considering PM. All women in the present study had previous genetic counselling and our results suggest that their interest in PM was not due to an overestimation of their personal risk.

Colon cancer screening practices after genetic counseling and testing for hereditary nonpolyposis colorectal cancer

PURPOSE

Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common hereditary form of colon cancer. Cancer screening recommendations differ between individuals identified to carry an HNPCC mutation and those who do not carry a known family mutation. We assessed the impact of genetic counseling and testing (GCT) on the use of endoscopic screening procedures and adherence to recommended endoscopic screening guidelines in 56 asymptomatic at-risk individuals from families known to carry an HNPCC mutation.

PATIENTS AND METHODS

We analyzed data on colonoscopy and flexible sigmoidoscopy screenings collected before GCT and 6 months and 12 months post-GCT on 17 mutation-positive and 39 true mutation-negative individuals. Main outcome measures were use of endoscopic screening and adherence to recommended guidelines for the relevant mutation status. Mutation status, age, sex, employment, and income were analyzed as predictor variables.

RESULTS

Among mutation-negative individuals, use of colonoscopy and flexible sigmoidoscopy decreased significantly between pre- and post-GCT (P <.00001 and P <.0003, respectively). Among mutation-positive individuals, a nonsignificant increase (P =.24) in use was noted. Age was also associated with use of endoscopic screening after GCT (P =.03). Mutation status (odds ratio [OR], 7.5; P =.02) and employment (OR, 8.6; P =.025) were associated with nonadherence to endoscopic screening guidelines. More mutation-negative individuals strictly adhered to guidelines than did mutation-positive individuals (87% v 65%).

CONCLUSION

Genetic counseling and testing for HNPCC significantly influences the use of colonic endoscopy and adherence to recommendations for colon cancer screening.

Stress response syndromes in women undergoing mammography: a comparison of women with and without a history of breast cancer

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.

Optimism, Perceived Risk of Breast Cancer, and Cancer Worry Among a Community-Based Sample of Women

Optimism is frequently inversely associated with distress; however, less is known about the mechanisms underlying this relationship. Optimism can be defined as having a generalized positive expectancy about the future. The authors hypothesized that a specific expectancy might mediate the relationship between optimism and distress. That model was tested using perceived risk of breast cancer as a specific measure of expectancy and cancer worry as a measure of distress in a community-based sample of 1,366 women. It was hypothesized that optimism would be inversely associated with cancer worry and that perceived risk of breast cancer would mediate the relationship between optimism and cancer worry. Multiple regression analyses revealed that perceived risk partially mediated the relationship between optimism and cancer worry.

Psychological Response to Test Results in an Ovarian Cancer Screening Program: A Prospective, Longitudinal Study

To identify the psychological impact of receipt of an abnormal yet benign screening test result, the authors examined the response to a transvaginal ultrasound screening (TVS) test for ovarian cancer (OC) in asymptomatic women (N=540) undergoing an initial TVS screening test. Interviews were conducted prior to undergoing TVS screening and at 2 weeks and 4 months following this baseline. Women receiving an abnormal yet benign TVS test result (n=33) reported elevated OC-specific, but not general, distress at 2-week follow-up. Distress returned to baseline levels at 4-month follow-up. Consistent with the monitoring process and cognitive-social health information processing models, response to an abnormal TVS result was moderated by a monitoring coping style, low optimism, and a family history of OC.

The relationship between perceived risk, affect, and health behaviors

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.