Skip to main content
Top
Published in: Journal of Genetic Counseling 5/2007

01-10-2007 | Original Research

Predictors of Cancer Worry in Unaffected Women from High Risk Breast Cancer Families: Risk Perception is not the Primary Issue

Authors: Melanie Anne Price, Phyllis Noami Butow, Sing Kai Lo, Judy Wilson, Kathleen Cuningham Consortium for Research into Familial Breast Cancer (kConFab) Psychosocial Group

Published in: Journal of Genetic Counseling | Issue 5/2007

Login to get access

Abstract

Some women at increased familial risk of breast cancer experience elevated levels of cancer-specific worry, which can possibly act as a barrier to screening, and may be a significant factor in decisions regarding risk-reducing surgery. The aim of this study was to comprehensively examine predictors of cancer-specific worry in high risk women and to test a model which proposes that perceived breast cancer risk mediates the impact of other factors on worry. 1,437 unaffected women from high risk breast cancer families completed questionnaires and interviews. Path analysis was used to test the model of potential predictors of cancer worry, including familial, personal and psychological variables, mediated via perceived cancer risk. Levels of cancer-specific worry were generally low despite an average perceived risk of 50.3%. The goodness-of-fit of the proposed model was poor, explaining only 9% of the variance for perceived risk and 10% of the variance for cancer specific worry. An alternative model of a direct relationship between all of the predictor variables and cancer worry, explained 24% of the variation in cancer worry. General anxiety, perceived risk, the stressful impact of recent cancer related events, a relative risk greater than 10, being closer in age to the youngest breast cancer diagnosis in family, and knowledge of personal mutation status, all independently contributed to cancer worry. Addressing general affective responses, experiences of recent cancer related events, in addition to education about personal risk, should be considered in counselling women with elevated cancer worry. Risk perception appears to act independently of other factors in its formulation and impact on cancer worry. Further research on the way in which women come to perceive their risk is indicated.
Literature
go back to reference Andersen, M., Smith, R., Meischke, H., Bowen, D., & Urban, N. (2003). Breast cancer worry and mammography use by women with and without a family history in a population-based sample. Cancer Epidemiology, Biomarkers & Prevention, 12, 314–320. Andersen, M., Smith, R., Meischke, H., Bowen, D., & Urban, N. (2003). Breast cancer worry and mammography use by women with and without a family history in a population-based sample. Cancer Epidemiology, Biomarkers & Prevention, 12, 314–320.
go back to reference Antoniou, A., Pharoah, P. D., Narod, S., Risch, H. A., Eyfjord, J. E., Hopper, J. L., et al. (2003). Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: A combined analysis of 22 studies. American Journal of Human Genetics, 72, 1117–1130.PubMedCrossRef Antoniou, A., Pharoah, P. D., Narod, S., Risch, H. A., Eyfjord, J. E., Hopper, J. L., et al. (2003). Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: A combined analysis of 22 studies. American Journal of Human Genetics, 72, 1117–1130.PubMedCrossRef
go back to reference Broadhead, W. E., Gehbach, S. H., de Gruy, F. V., & Kaplan, B. H. (1988). The Duke–UNC functional social support questionnaire. Medical Care, 26, 709–723.PubMedCrossRef Broadhead, W. E., Gehbach, S. H., de Gruy, F. V., & Kaplan, B. H. (1988). The Duke–UNC functional social support questionnaire. Medical Care, 26, 709–723.PubMedCrossRef
go back to reference Brown, G., & Harris, T. O. (1978). Social origins of depression: A study of psychiatric disorder in women. London: Tavistock. Brown, G., & Harris, T. O. (1978). Social origins of depression: A study of psychiatric disorder in women. London: Tavistock.
go back to reference Butow, P., Meiser, B., Price, M., Bennett, B., Tucker, K., Davenport, T., et al. (2005). Psychological morbidity in women at increased risk of developing breast cancer: A controlled study. Psycho-Oncology, 14, 196–203.PubMedCrossRef Butow, P., Meiser, B., Price, M., Bennett, B., Tucker, K., Davenport, T., et al. (2005). Psychological morbidity in women at increased risk of developing breast cancer: A controlled study. Psycho-Oncology, 14, 196–203.PubMedCrossRef
go back to reference Cella, D., Mahon, S. M., & Donovan, M. I. (1990). Cancer recurrence as a traumatic event. Behavioral Medicine, 16, 15–22.PubMedCrossRef Cella, D., Mahon, S. M., & Donovan, M. I. (1990). Cancer recurrence as a traumatic event. Behavioral Medicine, 16, 15–22.PubMedCrossRef
go back to reference Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357.PubMedCrossRef Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357.PubMedCrossRef
go back to reference Coyne, J. C., Kruus, L., Racioppo, M., Calzone, K. A., & Armstrong, K. (2003). What do ratings of cancer-specific distress mean among women at high risk of breast and ovarian cancer? American Journal Medical Genetics, 116A, 222–228.CrossRef Coyne, J. C., Kruus, L., Racioppo, M., Calzone, K. A., & Armstrong, K. (2003). What do ratings of cancer-specific distress mean among women at high risk of breast and ovarian cancer? American Journal Medical Genetics, 116A, 222–228.CrossRef
go back to reference Cull, A., Anderson, E. D. C, Campbell, S., Mackay, J., Smyth, E., & Steel, M. (1999). The impact of genetic counselling about breast cancer risk on women’s risk perception and levels of distress. British Journal of Cancer, 79, 501–508.PubMedCrossRef Cull, A., Anderson, E. D. C, Campbell, S., Mackay, J., Smyth, E., & Steel, M. (1999). The impact of genetic counselling about breast cancer risk on women’s risk perception and levels of distress. British Journal of Cancer, 79, 501–508.PubMedCrossRef
go back to reference Erblich, J., Bovbjerg, D. H., & Valdimarsdottir, H. B. (2000). Looking forward and back: Distress among women at familial risk for breast cancer. Annuals of Behavioral Medicine, 22, 53–59.CrossRef Erblich, J., Bovbjerg, D. H., & Valdimarsdottir, H. B. (2000). Looking forward and back: Distress among women at familial risk for breast cancer. Annuals of Behavioral Medicine, 22, 53–59.CrossRef
go back to reference Gerend, M. A., Aiken, L. S., West, S. G., Erchull, M. J. (2004). Beyond medical risk: Investigating the psychological factors underlying women’s perceptions of susceptibility to breast cancer, heart disease, and osteoporosis. Health Psychology, 23, 247–258.PubMedCrossRef Gerend, M. A., Aiken, L. S., West, S. G., Erchull, M. J. (2004). Beyond medical risk: Investigating the psychological factors underlying women’s perceptions of susceptibility to breast cancer, heart disease, and osteoporosis. Health Psychology, 23, 247–258.PubMedCrossRef
go back to reference Hay, J., Buckley, T. R., & Ostroff, J. S. (2005). The role of cancer worry in cancer screening: A theoretical and empirical review. Psycho-Oncology, 14, 517–534.PubMedCrossRef Hay, J., Buckley, T. R., & Ostroff, J. S. (2005). The role of cancer worry in cancer screening: A theoretical and empirical review. Psycho-Oncology, 14, 517–534.PubMedCrossRef
go back to reference Horowitz, M., Wilner, N., & Alverez, M. A. (1979). Impact of Events Scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–218.PubMed Horowitz, M., Wilner, N., & Alverez, M. A. (1979). Impact of Events Scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–218.PubMed
go back to reference Hurley, K. E., Miller, S. M., Costalas, J. W., Gillespie, D., & Daly, M. B. (2001). Anxiety/uncertainty reduction as a motivation for interest in prophylactic oophorectomy in women with a family history of ovarian cancer. Journal of Women's Health & Gender-Based Medicine, 10, 189–199.CrossRef Hurley, K. E., Miller, S. M., Costalas, J. W., Gillespie, D., & Daly, M. B. (2001). Anxiety/uncertainty reduction as a motivation for interest in prophylactic oophorectomy in women with a family history of ovarian cancer. Journal of Women's Health & Gender-Based Medicine, 10, 189–199.CrossRef
go back to reference Isaacs, C., Peshkin, B. N., Schwartz, M., Demarco, T. A., Main, D., & Lerman, C. (2002). Breast and ovarian cancer screening practices in healthy women with a strong family history of breast or ovarian cancer. Breast Cancer Research and Treatment, 71, 103–112.PubMedCrossRef Isaacs, C., Peshkin, B. N., Schwartz, M., Demarco, T. A., Main, D., & Lerman, C. (2002). Breast and ovarian cancer screening practices in healthy women with a strong family history of breast or ovarian cancer. Breast Cancer Research and Treatment, 71, 103–112.PubMedCrossRef
go back to reference Lerman, C., Daly, M., Sands, C., Balshem, A., Lustbader, E., Heggan, T., et al. (1993). Mammography adherence and psychological distress among women at risk for breast cancer. Journal of the National Cancer Institute, 85, 1074–1080.PubMedCrossRef Lerman, C., Daly, M., Sands, C., Balshem, A., Lustbader, E., Heggan, T., et al. (1993). Mammography adherence and psychological distress among women at risk for breast cancer. Journal of the National Cancer Institute, 85, 1074–1080.PubMedCrossRef
go back to reference Lerman, C., Narod, S., Schulman, K., Hughes, C., Gomez-Caminero, A., Bonney, G., et al. (1996). BRCA1 testing in families with hereditary breast-ovarian cancer. A prospective study of patient decision making and outcomes. JAMA, 275, 1885–1892.PubMedCrossRef Lerman, C., Narod, S., Schulman, K., Hughes, C., Gomez-Caminero, A., Bonney, G., et al. (1996). BRCA1 testing in families with hereditary breast-ovarian cancer. A prospective study of patient decision making and outcomes. JAMA, 275, 1885–1892.PubMedCrossRef
go back to reference Lerman, C., & Schwartz, M. (1993). Adherence and psychological adjustment among women at high risk for breast cancer. Breast Cancer Research and Treatment, 28, 145–155.PubMedCrossRef Lerman, C., & Schwartz, M. (1993). Adherence and psychological adjustment among women at high risk for breast cancer. Breast Cancer Research and Treatment, 28, 145–155.PubMedCrossRef
go back to reference Leventhal, H., Nerenz, D. R., & Steele, D. F. (1984). Illness representations and coping with health threats. In A. Baum, J. Singer, & N. J. Hillsdale (Eds.), A handbook of psychology and health (pp 219–252). Hillsdale: Erlbaum. Leventhal, H., Nerenz, D. R., & Steele, D. F. (1984). Illness representations and coping with health threats. In A. Baum, J. Singer, & N. J. Hillsdale (Eds.), A handbook of psychology and health (pp 219–252). Hillsdale: Erlbaum.
go back to reference Mann, G. J., Thorne, H., Balleine, R. L., Butow, P. N., Clarke, C. L., Edkins, E., et al. (2006). Analysis of cancer risk and BRCA1 and BRCA2 mutation prevalence in the kConFab familial breast cancer resource. Breast Cancer Research, 8(1), R12.PubMedCrossRef Mann, G. J., Thorne, H., Balleine, R. L., Butow, P. N., Clarke, C. L., Edkins, E., et al. (2006). Analysis of cancer risk and BRCA1 and BRCA2 mutation prevalence in the kConFab familial breast cancer resource. Breast Cancer Research, 8(1), R12.PubMedCrossRef
go back to reference McGregor, B., Bowen, D. J., Ankerst, D. P., Andersen, M. R., Yasui, Y., & McTiernan, A. (2004). Optimism, perceived risk of breast cancer, and cancer worry among a community-based sample of women. Health Psychology, 23, 339–344.PubMedCrossRef McGregor, B., Bowen, D. J., Ankerst, D. P., Andersen, M. R., Yasui, Y., & McTiernan, A. (2004). Optimism, perceived risk of breast cancer, and cancer worry among a community-based sample of women. Health Psychology, 23, 339–344.PubMedCrossRef
go back to reference Meiser, B. (2005). Psychological impact of genetic testing for cancer susceptibility: An update of the literature. Psycho-Oncology, 14, 1060–1074.PubMedCrossRef Meiser, B. (2005). Psychological impact of genetic testing for cancer susceptibility: An update of the literature. Psycho-Oncology, 14, 1060–1074.PubMedCrossRef
go back to reference Meiser, B., Butow, P., Barratt, A., Friedlander, M., Gattas, M., Kirk, J., et al. (1999). Attitudes to prophylactic oophorectomy and screening utilization in women at risk of developing hereditary breast/ovarian cancer. Gynecological Oncolology, 75, 122–129.CrossRef Meiser, B., Butow, P., Barratt, A., Friedlander, M., Gattas, M., Kirk, J., et al. (1999). Attitudes to prophylactic oophorectomy and screening utilization in women at risk of developing hereditary breast/ovarian cancer. Gynecological Oncolology, 75, 122–129.CrossRef
go back to reference Meiser, B., Butow, P., Friedlander, M., Schnieden, V., Gattas, M., Kirk, J., et al. (2000). Intention to undergo prophylactic bilateral mastectomy in women at increased risk of developing hereditary breast cancer. Journal of Clinical Oncology, 18, 2250–2257.PubMed Meiser, B., Butow, P., Friedlander, M., Schnieden, V., Gattas, M., Kirk, J., et al. (2000). Intention to undergo prophylactic bilateral mastectomy in women at increased risk of developing hereditary breast cancer. Journal of Clinical Oncology, 18, 2250–2257.PubMed
go back to reference Phillips, K. A., Butow, P. N., Stewart, A. E., Chang, J-H, Weideman, P. C., Price, M. A. et al. (2005). Predictors of participation in clinical and psychosocial follow up of the kConFab breast cancer family study. Familial Cancer, 4, 105–113.PubMedCrossRef Phillips, K. A., Butow, P. N., Stewart, A. E., Chang, J-H, Weideman, P. C., Price, M. A. et al. (2005). Predictors of participation in clinical and psychosocial follow up of the kConFab breast cancer family study. Familial Cancer, 4, 105–113.PubMedCrossRef
go back to reference Price, M. A., Tennant, C. C., Butow, P. N., Smith, R. C., Kennedy, S. J., Kossoff, M. B., et al. (2001). The role of psychosocial factors in the development of breast carcinoma: Part 2—Life event stressors, social support, defense style and emotional control and their interactions. Cancer, 91, 686–697.PubMedCrossRef Price, M. A., Tennant, C. C., Butow, P. N., Smith, R. C., Kennedy, S. J., Kossoff, M. B., et al. (2001). The role of psychosocial factors in the development of breast carcinoma: Part 2—Life event stressors, social support, defense style and emotional control and their interactions. Cancer, 91, 686–697.PubMedCrossRef
go back to reference Rees, G., Fry, A., & Cull, A. (2001). A family history of breast cancer: Women’s experiences from a theoretical perspective. Social Science and Medicine, 52, 1433–1440.PubMedCrossRef Rees, G., Fry, A., & Cull, A. (2001). A family history of breast cancer: Women’s experiences from a theoretical perspective. Social Science and Medicine, 52, 1433–1440.PubMedCrossRef
go back to reference Rogers, R. W. (1983). Cognitive and physiological processes in fear appeals and attitude change. In: J. Cacioppo & R. Petty (Eds.), Social Psychophysiology. New York: Guildford. Rogers, R. W. (1983). Cognitive and physiological processes in fear appeals and attitude change. In: J. Cacioppo & R. Petty (Eds.), Social Psychophysiology. New York: Guildford.
go back to reference Scheier, M. F., & Carver, C. S. (1985). Optimism, coping and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219–247.PubMedCrossRef Scheier, M. F., & Carver, C. S. (1985). Optimism, coping and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219–247.PubMedCrossRef
go back to reference Schwartz, M. D., Peshkin, B. N., Hughes, C., Main, D., Isaacs, C., & Lerman, C. (2002). Impact of BRCA1/BRCA2 mutation testing on psychologic distress in a clinic-based sample. Journal of Clinical Oncology, 20, 514–520.PubMedCrossRef Schwartz, M. D., Peshkin, B. N., Hughes, C., Main, D., Isaacs, C., & Lerman, C. (2002). Impact of BRCA1/BRCA2 mutation testing on psychologic distress in a clinic-based sample. Journal of Clinical Oncology, 20, 514–520.PubMedCrossRef
go back to reference Schwartz, M. D., Peshkin, B. N., Tercyak, K. P., Taylor, K. L., & Valdimarsdottir, H. (2005). Decision making and decision support for hereditary breast-ovarian cancer susceptibility. Health Psychology, 24, S78–84.PubMedCrossRef Schwartz, M. D., Peshkin, B. N., Tercyak, K. P., Taylor, K. L., & Valdimarsdottir, H. (2005). Decision making and decision support for hereditary breast-ovarian cancer susceptibility. Health Psychology, 24, S78–84.PubMedCrossRef
go back to reference Schwartz, M. D., Taylor, K. L., Willard, K. S., Siegel, J. E., Lamdan, R. M., & Moran, K. (1999). Distress, personality, and mammography utilization among women with a family history of breast cancer. Health Psychology, 18, 327–332.PubMedCrossRef Schwartz, M. D., Taylor, K. L., Willard, K. S., Siegel, J. E., Lamdan, R. M., & Moran, K. (1999). Distress, personality, and mammography utilization among women with a family history of breast cancer. Health Psychology, 18, 327–332.PubMedCrossRef
go back to reference Stefanek, M., Helzlsouer, K. J., Wilcox, P. M., Houn, F. (1995). Predictors of and satisfaction with bilateral prophylactic mastectomy. Preventative Medicine, 24, 412–419.CrossRef Stefanek, M., Helzlsouer, K. J., Wilcox, P. M., Houn, F. (1995). Predictors of and satisfaction with bilateral prophylactic mastectomy. Preventative Medicine, 24, 412–419.CrossRef
go back to reference Tyrer, J., Duffy, S.W., Cuzick, J. (2004) A breast cancer prediction model incorporating familial and personal risk factors. Statistics in Medicine, 23, 1111-1130PubMedCrossRef Tyrer, J., Duffy, S.W., Cuzick, J. (2004) A breast cancer prediction model incorporating familial and personal risk factors. Statistics in Medicine, 23, 1111-1130PubMedCrossRef
go back to reference van Dooren, S., Seynaeve, C., Rijnsburger, A. J., Duivenvoorden, H. J., Essink-Bot, M. L., Bartels, C. C. M., et al. (2005). The impact of having relatives affected with breast cancer on psychological distress in women at increased risk for hereditary breast cancer. Breast Cancer Research and Treatment, 89, 75–80.PubMedCrossRef van Dooren, S., Seynaeve, C., Rijnsburger, A. J., Duivenvoorden, H. J., Essink-Bot, M. L., Bartels, C. C. M., et al. (2005). The impact of having relatives affected with breast cancer on psychological distress in women at increased risk for hereditary breast cancer. Breast Cancer Research and Treatment, 89, 75–80.PubMedCrossRef
go back to reference Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.PubMedCrossRef Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.PubMedCrossRef
Metadata
Title
Predictors of Cancer Worry in Unaffected Women from High Risk Breast Cancer Families: Risk Perception is not the Primary Issue
Authors
Melanie Anne Price
Phyllis Noami Butow
Sing Kai Lo
Judy Wilson
Kathleen Cuningham Consortium for Research into Familial Breast Cancer (kConFab) Psychosocial Group
Publication date
01-10-2007
Publisher
Springer US
Published in
Journal of Genetic Counseling / Issue 5/2007
Print ISSN: 1059-7700
Electronic ISSN: 1573-3599
DOI
https://doi.org/10.1007/s10897-007-9105-4

Other articles of this Issue 5/2007

Journal of Genetic Counseling 5/2007 Go to the issue