Anxiety, Depression in Women at High Risk for Breast Cancer

WASHINGTON—A substantial minority of the women who see themselves as being at high risk for breast cancer because of family history suffer noticeable depressive symptoms and anxiety, and the anxiety can interfere with compliance with recommendations on breast self-examination (BSE), according to studies at the UCLA Revlon Breast Center.

Nangel Lindberg, PhD, of the Revlon Breast Center, and David Wellisch, PhD, professor in residence and chief psychologist for the Adult Services Division of the UCLA Medical School Department of Psychiatry, reported findings on 430 patients attending the Revlon Center’s high-risk breast clinic. They spoke at the American Psychological Association Conference on Enhancing Outcomes in Women’s Health.

"It’s not enough to present information about cancer and risk to such women," Dr. Wellisch said. "The anxiety must be managed." Depression, however, does not appear to affect compliance in these women.

Women are selected to attend the multidisciplinary clinic mostly because of elevated familial risk, and the clinic staff is "trying to assemble a basic literature on the psychosocial features" of this population, Dr. Wellisch explained.

Initial intake includes psychological screening tests and questionnaires about familial breast cancer history and the women’s demographic characteristics. In this study, 88% of the patients had first-degree relatives with breast cancer—their mothers in 71% of cases, a sister in 16%, and both in 13%. Two affected relatives is the average, but 28% of the women had three or more; one woman had 26.

Five percent lacked a familial history of breast cancer but had precancerous breast changes such as lobular carcinoma in situ, and 6% had both a family history and breast changes.

The women ranged in age from 15 to 78. Eighty-four percent were white, 73% had college or graduate education, and nearly all were of high socioeconomic status.