High-Risk Women Less Likely to Perform BSE Regularly

PALM SPRINGS, Calif--Women often develop idiosyncratic ideas abouttheir risk for breast cancer, Mary Jane Massie, MD, said at theAcademy of Psychosomatic Medicine in a session on counseling high-riskwomen. And the higher the perceived risk, the less likely thesewomen may be to confront their fears and comply with preventiveregimens such as breast self-exam (BSE).

"Breast cancer gets more play in the media than any otherdisease right now, so it is important for us to be able to teachpatients the real risk factors," said Dr. Massie, attendingpsychiatrist and director, Barbara White Fishman Center for PsychologicalCounseling, Evelyn Lauder Breast Cancer Center, Memorial Sloan-KetteringCancer Center.

This type of education for high-risk women is available at high-risksurveillance clinics such as the one at Memorial Sloan-Kettering,which is staffed by surgeons, plastic surgeons, nurses, psychiatrists,psychologists, genetics counselors, and nutritionists.

Women are referred to the clinic because they have a family historyof breast cancer or have atypical breast changes. Frequently,these women are young, often the daughters or sisters of womenwho have had breast cancer.

At the Memorial surveillance clinic, regular monitoring of womenat high risk includes clinical breast examinations every 6 months.Mammography schedules are determined by a surgeon, based on thewoman's age and evidence of atypical changes in the breasts, Dr.Massie said.

Those women who are too anxious to perform BSE on a regular scheduleshould be told that their physician will perform the examination,but they may need to be seen more frequently.

Study Shows Low BSE Performance

Pierre Gagnon, MD, a psychiatrist at the Hotel Dieu Hospital,Quebec City, reported on his research of women who presented atMemorial's high-risk surveillance clinic. He discovered that 61%of these women performed BSE less than once a month, and 59% ofthem expressed a lack of confidence in their ability to performBSE adequately.

These women also significantly overestimated their risk, perceivingthat they had an average of a 53% likelihood of developing breastcancer, when, in fact, the mean of their calculated risk was approximately18%, Dr. Gagnon said.

As a group, these women were more psychologically distressed,showing elevated scores on almost every measure of the Brief SymptomInventory, compared with a control group.

Dr. Gagnon found that by offering women information designed tocorrect their misperceptions of their risk, as well as informationabout the importance of regular BSE, the women's perception oftheir risk declined, as did their anxiety about cancer. Therewas, however, no improvement in frequency of performing BSE.

High Anxiety Levels

A study by Kathryn Kash, PhD, psychologist at the Strang CancerPrevention Center, New York, showed similar findings.

Dr. Kash found that women at high risk for developing breast cancertended to have higher levels of anxiety about developing breastcancer and were less likely to perform BSE, or present for routinemammog-raphy or clinical follow-up.

These women are younger and they have greater anxiety about breastcancer, which is specifically coupled with more intrusive thoughtsabout their risk of breast cancer, Dr. Kash said. Interestingly,this group also tended to be more knowledgeable about breast cancerthan the average woman.

In Dr. Kash's study, 75% of these high-risk women overestimatedtheir risk of developing breast cancer. Consequently, this exaggeratedfear interferes with their compliance with both BSE and clinicalfollow-up.

Dr. Massie commented that "the very group of women we wouldlike to be attending high-risk clinics, examining themselves,or seeking more assistance from their physicians are likely womenwho are too anxious to comply with these recommendations."

Dr. Payne is the Barbara White Fishman Psychiatry Fellow, PsychiatryService, Memorial Sloan-Kettering Cancer Center, New York.