Breast cancer risk perceptions linked to anxiety in patients

Breast cancer risk perceptions linked to anxiety in patients

By Catherine Walker

Elevated levels of anxiety may cause women with the most common form of non-invasive breast cancer to overestimate their risk of recurrence or dying from breast cancer according to a study led by Dana-Farber researchers.

This form of caner is Ductal carcinoma in situ (DCIS).  It is characterised by the uncontrolled growth of cells within a breast’s milk ducts.  The risk of DCIS spreading elsewhere is approximately 1% after mastectomy and less than 10% after breast-conserving surgery.

‘Although DCIS typically is a very treatable disease, many women diagnosed with DCIS develop inaccurate risk perceptions’ said Ann Partridge, MD, MPH, the study lead author.  ‘This exaggerated sense of risk needs to be addressed as it may cause women to make poor treatment choices and adversely affect their emotional well-being and subsequent health behaviours.’

The findings of this study are published online by the Journal of the National Cancer Institute.

The incidence of DCIS in the U.S. has increased in the last 20 years and Partridge says that the growing number of DCIS cases underscores the need to develop a better understand of how a DCIS diagnosis impacts women’s emotional health.

A study of women who were recently diagnosed with DCIS to measure risk perceptions and its association with anxiety and depression was undertaken. 

Of the 764 eligible participants 487 completed the initial survey.  Women were subsequently surveyed at nine months (426 completed) and 18 months (392 completed).

• 55% of the respondents to the initial survey thought that they had at least a ‘moderate likelihood’ of their DCIS recurring within five years of diagnosis. 
• 68% thought it was at least moderately likely to recur within their lifetime. 
• 28% responded that it was at least moderately likely that the DCIS would spread elsewhere in the body.

The participants’ risk perception remained statistically unchanged over the study’s 18-month duration.

Anxiety was most consistently associated with a woman’s misperceptions of elevated risk.  A woman with heightened anxiety was more likely to think that her DCIS would recur within five years or that it would become invasive breast cancer within five years or sometime during her lifetime.

Partridge says that the study’s findings pose a ‘chicken and the egg’ conundrum.  ‘Are women with higher anxiety more likely to misperceive their risk or are women somehow developing inaccurate risk perceptions and thus developing anxiety?  I’m not sure that question can be answered at this point.’  She says the findings underscore the need and importance of better doctor-patient communications and the need for further research in this area.

‘Some of the anxiety is clearly tied to our society’s fears about breast cancer’ Partridge explains.  ‘A woman may also have multiple are providers, medical oncologist, surgeon, plastic surgeon, internist...and may hear mixed messages about her risks.  Improved understanding of DCIS on the part of the medical community may also help women make better, more informed decisions about their care,’ she concluded.

Source: Dana-Faber Cancer Institute