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Mammography more stressful for survivors of disease

2004 MAR 1 - (NewsRx.com & NewsRx.net) -- The stress of mammography after surviving breast cancer may cause health risks beyond having a history of the disease itself, a new study suggests.

Breast cancer survivors find follow-up mammography more stressful than do women who have never had the disease, or even those who are newly diagnosed, the researchers say.

"Women with a previous cancer diagnosis reported two to four times as many acute stress symptoms as women with no previous cancer," says Maria Gurevich, PhD, of Toronto's Ryerson University and Princess Margaret Hospital.

The study appeared in the January/February 2004 issue of the journal Psychosomatic Medicine.

Psychological stress may result from any aspect of mammography, Gurevich says, arising before screening, at the time of the test itself, while awaiting results or after hearing the outcome.

Such stress may influence future health. Memories of their earlier cancer diagnosis may affect survivors' willingness to return for regular follow-up mammograms or to find them more stressful when they do go. Some avoid these checkups altogether, even though the American Society of Clinical Oncology recommends annual mammograms for survivors of breast cancer. Earlier studies showed that 30% of survivors had not received a mammogram in the prior year.

"This raises the question of why women may be reluctant to undergo regular follow-up mammograms," Gurevich says. "Our study suggests that perhaps the experience triggers distressing memories or prior cancers."

Gurevich and colleagues assessed 135 women undergoing mammography at a large cancer center in Toronto. Sixty-six women had survived breast cancer earlier, while the other 69 women never had the disease. The mammograms for this study revealed that all 135 women were free of cancer. The women answered questions about stress levels, trauma history, psychiatric history, social support, and physician support.

According to the Health Behavior News Service, the study confirmed that even routine follow-up care and good mammography results could still trigger anxiety by recalling earlier bouts with cancer, Gurevich says.

"Survivors of breast cancer may experience heightened cancer-related fears, even after they have received negative mammography results," she says.

Having already lived for an average of 6.5 years after their first experience with breast cancer, two-thirds of these women could expect a favorable outcome. Nevertheless, these cancer survivors scored even higher on tests of acute stress than women who were newly diagnosed with breast cancer, Gurevich reports, comparing her results with an earlier study.

"The experience of previous cancer may have a persistent influence on health-related threats and events," she says, "even in the absence of recurring disease."

The study also pointed out the role physicians play in the connection between stress and mammography. Strong support from their physicians was associated with lower rates of stress for women who had never had cancer, but not for the cancer survivors.

"Among women with previous cancer, greater perceived physician support was associated with higher stress-related symptom levels," Gurevich reports.

This association did not mean that doctors caused their patients' symptoms, but rather that the patients' distress stimulated the physicians' concern.

Increased stress responses for the women were also associated with pre-mammography breast complaints, lower income, previous psychiatric medication use, and greater sensitivity to physical sensations not related to illness.

Detecting stress-related symptoms in response to mammography may be useful, says Gurevich, because they may adversely affect health-related decision making and other ongoing disease monitoring activities, like regular mammography, clinical breast examinations, or breast self-examinations. Future research needs to assess directly whether this relationship exists and how healthcare providers can intervene, she says.

For more information, contact Maria Gurevich at mgurevic@ryerson.ca. This article was prepared by Health & Medicine Week editors from staff and other reports. Copyright 2004, Health & Medicine Week via NewsRx.com & NewsRx.net.

©Copyright 2004, Health & Medicine Week via NewsRx.com & NewsRx.net

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