Perception of breast cancer risk and psychological distress in women attending a surveillance program

Women at high risk of developing breast cancer who attend surveillance programs (SP) overestimate their risk and are highly anxious; those who are anxious are less likely to perform breast self-examination (BSE). We attempted to determine if counseling by a breast surgeon could increase women's accuracy of risk perception and hence decrease their anxiety and increase their likelihood of performing BSE. We also tested the efficacy of a series of four informative newsletters in reducing anxiety. All 145 women who scheduled an initial appointment during one year for our SP were asked to participate; 94 women completed a self-report questionnaire containing validated instruments before their first SP visit. Of these, 41 women were randomly selected to receive the newsletter. Women were mailed follow-up questionnaires at 2 and 4 months after their initial visit. Of the sample, 76% overestimated their risk of developing breast cancer by at least doubling their actual risk as measured with empiric risk tables. Their psychological distress was between 0.5 to 1 standard deviation above normative scores. Being older and having greater confidence in the ability to perform BSE were the only variables that predicted performance of BSE. A follow-up assessment performed 4 months after the initial visit showed a significant improvement in the accuracy of perception of risk (p < 0.01) and a reduction of cancer anxiety (p < 0.05), but no significant change in performance of BSE. The newsletters produced no significant effect. Women attending a breast surveillance program showed a significant improvement in their ability to estimate the risk of developing breast cancer and a reduction in their anxiety after counseling, but no significant change in performance of BSE. The possibility that improvement in risk perception and reduction of cancer anxiety can lead to greater adherence to screening behaviors needs to be tested with a larger number of women and over a longer time period.