Benign Breast Disease, Biopsy & Cancer Preventive Self-Care

Institution: University of California, Davis
Investigator(s): Jacqueline O'Connor, Ph.D. -
Award Cycle: 1995 (Cycle I) Grant #: 1KB-0134 Award: $224,351
Award Type: New Investigator Awards
Research Priorities
Detection, Prognosis and Treatment>Imaging, Biomarkers, and Molecular Pathology: improving detection and diagnosis

Initial Award Abstract (1995)
The rates of benign breast disease indicate that a substantial number of pre- and postmenopausal women have experienced the discovery, biopsy, and diagnosis of benign (i.e., non-cancerous) breast disease -- a sequence of events that our research team refers to collectively as a breast health crisis. The limited psychological research to date supports the idea that these experiences constitute a stressful life event, and for some, a life crisis. Our multidisciplinary research team proposes to conduct a longitudinal study of psychological and behavioral processes in breast self-care following biopsy and diagnosis of benign breast disease. The goal of this study is to identify the most important elements of the psychological self-appraisal system that regulates preventive breast self-care, and to describe the dynamic relations among those elements that predict continuity and discontinuity in self-care following an acute threat to breast health. (We define self-care in terms of all three components of cancer preventive behavior: performing breast self-examination, obtaining a mammogram, and having a clinical breast examination.)

There is evidence from previous research that self-care routines may be disrupted in the aftermath of a breast health crisis, although to date there are no published long-term follow-up studies to assess patterns of stability or change following a benign breast diagnosis. In addition, although some types of benign breast disease have been associated with an increased risk of breast cancer, many women with a history of benign breast disease do not comply with recommended guidelines for breast self-examination, screening mammography, and clinical breast examinations.

We plan to prospectively monitor breast health knowledge, beliefs, and behaviors in approximately 200 women who have recently undergone investigative medical procedures including breast biopsy, for benign breast disease, as well as a large control sample of approximately 300 women, for the entire duration of the 3-year study period. Data collection will include measures of stress and coping through a breast health crisis: breast cancer knowledge, beliefs, and attitudes; personal appraisal of susceptibility, breast cancer-related anxiety, and efficacy regarding self-care practices; and interval tracking of breast self-care behaviors.

The significance of this project in terms of the Breast Cancer Research Program's emphasis on early detection is that the occurrence of a benign breast disease may present an opportunity for positive intervention related to subsequent breast self-care, or may, on the other hand, overwhelm a woman's coping resources, leaving her feeling vulnerable, powerless, and unmotivated to adopt or continue preventive self-care. Therefore, the study we propose of psychological and behavioral processes in breast self-care in the presence -- and absence -- of a benign breast disease history can make a valuable contribution to our understanding of important aspects of personal behavior that affect early detection, and through such understanding to help achieve the broader goal of reducing the human and economic costs of breast cancer among all women.

Final Report (1999)
The specific aims of this research project are to identify psychological characteristics that motivate breast cancer early detection practices, and variables that predict continuity and discontinuity in health practices following the threat to breast health. We followed approximately 450 women for a period of three years. Participants entered the study having recently undergone a biopsy or other breast diagnostic procedure (e.g., ultrasound) with negative or benign (noncancerous) results, and we included a group of women with no history of breast problems. Thus far, our results converge on several key conclusions:

Age and psychosocial aspects of breast health: Younger women find routine breast cancer screening and diagnostic experiences to be more stressful, on average, than do older women. One intriguing interpretation is that younger women have been exposed, more than other generations of women, to widespread, energetic campaigning and public education about breast cancer. The resulting heightened awareness may also carry with it an increased sense of vulnerability, and consequent stress around screening and diagnostic procedures. Indeed, even among participants who entered this study with no history of breast problems, younger women reported feeling more at risk and vulnerable to developing breast cancer, on average, than did older women, despite their awareness that breast cancer risk increases with age.

Psychological consequences of a threat to breast health: Overall, women who have experienced a false positive mammogram or have undergone breast biopsy report greater anxiety about breast cancer and heightened perceptions of personal vulnerability than do women who have had only routine screenings with normal outcomes, and these feelings of vulnerability may last for more than a year following the diagnostic event.

Behavioral consequences of a threat to breast health: Our most significant finding to date is that despite increased feelings of vulnerability and breast cancer anxiety, a "breast cancer scare" generally does not lead to reduced rates of breast self examination, or of obtaining subsequent mammograms or clinical breast exams. In fact, many women noted that their experience prompted them to be more vigilant about their breast health and compliant with recommended screening guidelines.

It is our intention and our hope that findings from this project will deepen our understanding of psychosocial aspects of breast cancer and cancer screening, advance the cause of early breast cancer detection, and ultimately contribute to reducing the human and economic costs of breast cancer.

Short-interval follow-up mammography versus immediate core biopsy of benign breast lesions: assessment of patient stress
Periodical:American Journal of Roentgenology
Index Medicus: Am J Roentgenol
Authors: Lindfors KK, O'Connor J, Acredolo CR, Liston SE.
Yr: 1998 Vol: 17 Nbr: 1 Abs: Pg:55-58

False-positive Screening Mammograms: Effect of Immediate versus Later Work-up on Patient Stress
Index Medicus: Radiology
Authors: Lindfors KK, O'Connor J, Parker, RA
Yr: 2001 Vol: 218 Nbr: 1 Abs: Pg:247-253