Psychological Distress and Surveillance Behaviors of Women With a Family History of Breast Cancer

Abstract

Women with a family history of breast cancer are at increased risk for developing the disease. This study investigated the beliefs of women at high risk for breast cancer (one or more first-degree relatives with breast cancer) about their breast cancer risk and the impact of this information on their surveillance behaviors and psychological distress. The Health Belief Model and the Fear Arousing Communications Theory were used in this study. Two hundred and seventeen women, enrolled in a breast protection program, completed a questionnaire regarding health beliefs and behaviors, social support, and psychological distress. While 94% came in for regularly scheduled mammograms, only 69% came in for regular clinical breast examinations. A discriminant function analysis revealed that increased cancer anxiety decreased regular clinical examinations (coefficient = −. 65). Only 40% performed breast self-examination monthly. High breast self-examination performance prior to coming to the program was the best predictor of current 10% never performed breast self-examination, and 50% did not perform breast self-examination regularly. High breast self-examination performance prior to coming to the program was the best predictor of current breast self-examination, and high anxiety predicted poor adherence to monthly breast self-examination (multiple R =. 61). More than 27% of the women at high risk were defined as having a level of psychological distress consistent with the need for counseling. Women reporting more barriers to screening, fewer social supports, and low social desirability had more psychological distress (multiple R =. 75). Higher anxiety was directly related to poor attendance at a clinical breast examination and poor adherence to monthly breast self-examination. These data support the need for developing psychological interventions for women at high risk for breast cancer in an effort to reduce distress, improve surveillance behaviors, and assure the earliest detection of breast cancer. [J Natl Cancer Inst 84: 24–30, 1992]