Conditioned emotional distress in women receiving chemotherapy for breast cancer.

This study investigated whether women undergoing outpatient chemotherapy for breast cancer can develop classically conditioned emotional distress. Women scheduled to begin chemotherapy were randomly assigned either to an experimental group (exposed to a distinctive stimulus before each chemotherapy infusion) or a control group. After repeated infusions of chemotherapy, patients' responses to the distinctive stimulus were assessed in a location not associated with chemotherapy administration. At the test trial, experimental group patients showed evidence of increased emotional distress (self-reported on a visual analog scale) after the presentation of the distinctive stimulus, whereas control group patients did not. Post hoc analyses indicated that these increases in distress were not secondary to other conditioned responses (e.g., nausea, taste aversion). Thus, results supported the hypothesis that the pairing of a distinctive stimulus with chemotherapy would result in the development of a conditioned emotional response. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping disposition, perceived risk, and psychological distress among women at increased risk for ovarian cancer.

The authors examined predictors of psychological distress among women who were at increased risk for ovarian cancer. Participants were 103 women who had at least 1 first degree relative with ovarian cancer. Specifically, the authors tested the relationship between the dispositional attentional style of monitoring (the tendency to scan for threat-relevant information), perceptions of risk for ovarian cancer, intrusive thoughts regarding ovarian cancer, and psychological distress. Overall, this sample exhibited moderately high levels of psychological distress. High scores on monitoring were associated with high perceived risk for ovarian cancer and elevated levels of intrusive thoughts and psychological distress. Finally, the authors proposed and tested a path model describing the interrelationships between these variables. Results of this study are discussed in terms of their implications for treating the psychological distress associated with being at increased risk for ovarian cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interdependence in women with breast cancer and their partners: An interindividual model of distress.

Objective: The aim of this investigation was to test whether interdependence in dyads living with breast cancer could account for person–partner crossover effects in distress outcomes. Method: The sample consisted of 95 dyads with early-stage breast cancer. By using reciprocal dyadic data from women with breast cancer and their partners, we fit a structural equation model of the actor–partner interdependence model to examine the interaction of participants’ depression and stress in predicting their partner’s health outcomes. Results: Results revealed a pattern of influence whereby the interaction of high levels of depression coupled with high levels of stress in women with breast cancer was associated with lowered physical health and well-being in their partners. Although depression seemed to be the key mechanism in predicting distressing outcomes, when depression was combined with any additional stress, the level of physical distress was significantly greater. Results provided preliminary empirical support for crossover effects in the physical well-being of close relational partners in a cancer-related context. Further, results showed that distressing outcomes need not be limited to emotional distress but can also include physical distress. Conclusions: The findings from this study illustrate why it is not sufficient to concentrate care solely on the patient with cancer. Monitoring the social well-being of patients as they go through the cancer process could be as important as assessing their psychological state or other peripheral biomarkers. This line of inquiry would be advanced by including methods other than self-report in assessments of psychological and physical health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical activity and the risk of breast cancer

BACKGROUND: Because physical activity may affect hormonal concentrations and energy balance, we decided to investigate whether everyday exercise is related to the risk of breast cancer. METHODS: During 1974 to 1978 and 1977 to 1983, a total of 25,624 women, 20 to 54 years of age at entry, enrolled in health surveys and answered questionnaires about leisure-time and work activity. RESULTS: During a median follow-up of 13.7 years, we identified 351 cases of invasive breast cancer among the 25,624 women in the cohort. Greater leisure-time activity was associated with a reduced risk of breast cancer, after adjustments for age, body-mass index (the weight in kilograms divided by the square of the height in meters), height, parity, and county of residence (relative risk, 0.63; 95 percent confidence interval, 0.42 to 0.95), among women who exercised regularly, as compared with sedentary women (P for trend=0.04). In regularly exercising women, the reduction in risk was greater in premenopausal women than in postmenopausal women, and greater in younger women (<45 years at study entry) than in older women (> or =45 years) (relative risk, 0.38; 95 percent confidence interval, 0.19 to 0.79). In stratified analyses the risk of breast cancer was lowest in lean women (body-mass index, <22.8) who exercised at least four hours per week (relative risk, 0.28; 95 percent confidence interval, 0.11 to 0.70). The risk was also reduced with higher levels of activity at work, and again there was a more pronounced effect among premenopausal than postmenopausal women. CONCLUSIONS: Physical activity during leisure time and at work is associated with a reduced risk of breast cancer.     

The effect of varied physician affect on recall, anxiety, and perceptions in women at risk for breast cancer: An analogue study.

Evaluated the effect of varied physician affect on recall, anxiety, and perceptions in a simulated tense and ambiguous medical situation. 40 women (aged 19–54 yrs) at risk for breast cancer viewed videotapes of an oncologist presenting (with either worried or nonworried affect) mammogram results. Although the mammogram results and the oncologists were the same in both presentations, analyses indicated that, compared with Ss receiving results from a nonworried physician, Ss receiving the results from a worried physician recalled significantly less information, perceived the clinical situation as significantly more severe, reported significantly higher levels of state anxiety, and had significantly higher pulse rates. Physician affect appears to play a critical role in patient reaction to medical information. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role conflict and symptoms of psychological distress in college-educated women.

Studied sex role attitudes, need for achievement, and employment patterns of 136 women's college graduates out of college 10 yrs and 132 out of college 25 yrs in relation to symptoms of mental illness using a 3-wave mail questionnaire technique. Questionnaire returns totaled 71% of the selected sample and established validity of the Twenty-Two Item Screening Score in mail questionnaire studies. Neither employment status nor achievement motivation, assessed by stories written in response to verbal cues, were significantly related to symptom scores. However, Ss with contemporary sex role orientations, as indicated by the Revised Fand Inventory, exhibited significantly higher symptom scores. Also, the class out of college 10 yrs had significantly more members (a) with high need for achievement, (b) with contemporary sex role orientation, and (c) who had advanced degrees and were earning higher incomes. They also had significantly higher symptom scores. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trait anxiety, symptom perceptions, and illness-related responses among women with breast cancer in remission during a tamoxifen clinical trial.

Postmenopausal women with breast cancer in remission (N?=?140) who were participating in a randomized clinical trial of tamoxifen chemoprevention therapy completed measures of trait anxiety, symptoms, cancer worry, and breast self-examinations (BSEs) during the first 6 months of the trial. Trait anxiety was associated with heightened sensitivity to tamoxifen-induced symptoms (but not with tendencies to report increases in symptoms unrelated to tamoxifen use), greater tendencies to attribute symptoms to tamoxifen use, and greater cancer worry. Tamoxifen use increased BSE rates among high-anxiety participants. For low-anxiety participants, tamoxifen use increased cancer worry but not BSE rates. Trait anxiety appears to be associated with vigilant activation of illness-related representations that trigger attentiveness to sensations, worry, and protective coping in response to somatic cues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Partner unsupportive responses, avoidant coping, and distress among women with early stage breast cancer: Patient and partner perspectives.

This 18-month longitudinal study examined the associations among partner unsupportive behavior, avoidant coping, and distress experienced by 219 women with early stage breast cancer. The role of patient and partner ratings of unsupportive behavior were evaluated. Results indicated that patient and partner ratings of unsupportive behavior were highly correlated. Growth curve modeling suggested that unsupportive behavior, from both patient and partner perspectives, predicted more avoidant coping and distress. When partner and patient perceptions were placed in the same model, patient perceptions mediated the association between partners' ratings of their unsupportive behavior and patient distress. Avoidance also mediated the association between unsupportive behavior and distress, extending prior cross-sectional findings. Results highlight the long-term detrimental effects of partners' unsupportive behavior on the quality of life of women with early stage breast cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Specific worry about breast cancer predicts mammography use in women at risk for breast and ovarian cancer.

This longitudinal study examined predictors of mammography use among women with a family history of breast cancer participating in a risk assessment and surveillance program (N?=?213). Assessed were background variables (age, prior mammography utilization), cognitive variables (perceived vulnerability), and affective variables (cancer worry and general distress). Results of logistic regression analyses predicting adherence 1 year after baseline contact, in which variables of prior utilization, feelings of vulnerability, and general distress were controlled for, indicated that and age were significant predictors of mammography adherence. Results suggest that moderate levels of cancer worry facilitate, rather than undermine, adherence. The results have implications for the construction of educational messages that should be designed to acknowledge feelings of cancer-specific worry and to provide guidance in health protective behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical activity and risk of colorectal cancer in men and women

We examined the association between self-reported occupational and recreational physical activity and the subsequent risk of colorectal cancer in a population-based cohort in Norway. During a mean follow-up time of 16.3 years for males and 15.5 years for females, 236 and 99 colon cancers and 170 and 58 rectal cancers were observed in males and females, respectively, among 53,242 males and 28,274 females who attended the screening between 1972 and 1978. Physical activity at a level equivalent to walking or bicycling for at least four hours a week during leisure-time was associated with decreased risk of colon cancer among females when compared with the sedentary group (RR = 0.62, 95% CI 0.40-0.97). Reduced risk of colon cancer was particularly marked in the proximal colon (RR = 0.51, 95% CI 0.28-0.93). This effect was not observed for occupational physical activity alone, probably due to a narrow range of self-reported physical activity at work among females. However, by combining occupational and recreational physical activity we observed an inverse dose-response effect as increasing total activity significantly reduced colon cancer risk (P for trend = 0.04). Among males 45 years or older at entry to the study, an inverse dose-response effect was observed between total physical activity and colon cancer risk (P for trend = 0.04). We also found in males a stronger preventive effect for physical activity in the proximal as compared to distal colon. In addition, we found a borderline significant decrease in colon cancer risk for occupational physical activity in males 45 years or older when compared to the sedentary group (RR = 0.74, 95% CI 0.53-1.04). All results were adjusted for age, body mass index, serum cholesterol and geographic region. No association between physical activity and rectal cancer was observed in males or females. The protective effect of physical activity on colon cancer risk is discussed in regard to energy balance, dietary factors, age, social class, body mass index and gastrointestinal transit time.     

Radial scars in benign breast-biopsy specimens and the risk of breast cancer

BACKGROUND: Radial scars are benign breast lesions of uncertain clinical significance. In particular, it is not known whether these lesions alter the risk of breast cancer in women with benign breast disease. We conducted a case-control study of women who had benign breast lesions with or without radial scars. METHODS: We reviewed benign breast-biopsy specimens from 1396 women enrolled in the Nurses' Health Study, including 255 women in whom breast cancer subsequently developed and 1141 women without subsequent breast cancer (controls). The controls were matched to the women with subsequent breast cancer according to age and the year when the benign lesion was identified. The median follow-up after biopsy of the benign lesions was 12 years. RESULTS: Radial scars were identified in biopsy specimens from 99 women (7.1 percent). Most biopsy specimens with radial scars had only one radial scar (60.6 percent), and they tended to be incidental microscopical findings (median size, 4.0 mm). The women with radial scars had a risk of breast cancer that was almost twice the risk of the women without scars, regardless of the histologic type of benign breast disease (relative risk, 1.8; 95 percent confidence interval, 1.1 to 2.9). Among women who had proliferative disease without atypia as compared with women who had nonproliferative disease, the relative risk of breast cancer was 3.0 (95 percent confidence interval, 1.7 to 5.5) for those with radial scars and 1.5 (95 percent confidence interval, 1.1 to 2.1) for those without radial scars. Among women with atypical hyperplasia as compared with women with nonproliferative disease, the relative risk of breast cancer was 5.8 (95 percent confidence interval, 2.7 to 12.7) for those with radial scars and 3.8 (95 percent confidence interval, 2.4 to 5.9) for those without radial scars. CONCLUSIONS: Radial scars are an independent histologic risk factor for breast cancer.     

Responsiveness to threats and incentives, expectancy of recurrence, and distress and disengagement: Moderator effects in women with early stage breast cancer.

Models of neurobiological systems linking personality, motivation, and emotion can be integrated with the expectancy construct to suggest hypotheses about distress and giving up in response to adversity. In 220 women with breast cancer, threat responsiveness—sensitivity of the behavioral inhibition system (BIS)—and incentive responsiveness—sensitivity of the behavioral activation system (BAS)—and expectancies about cancer recurrence were measured. It was predicted and found that high BIS sensitivity interacted with recurrence expectancy to predict elevated distress and disengagement. Low BAS sensitivity (reward responsiveness) also interacted with expectancy of recurrence to predict elevated disengagement. In contrast, high BAS sensitivity (fun seeking) interacted with recurrence expectancy to predict elevated distress. Discussion centers on theoretical implications and possible applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breastfeeding experience and breast cancer risk among postmenopausal women

A method of automated detection of onset and termination of rhythmic muscle activity in electromyograms (EMGs) is presented. A threshold level in the EMG is computed, such that amplitudes in the EMG signal exceeding this level indicate muscle activity. The threshold level is determined using a statistical criterion based on the amplitude distribution of the entire EMG signal. The working of the method is illustrated with EMG signals recorded from chewing muscles. EMG signals with a good as well as a worse signal-to-noise ratio are presented. The method can be used for any EMG signal containing cyclic bursts of activity and thus may be applied in studies on rhythmic movements, such as chewing, walking and breathing. An automated method of EMG burst detection has the advantage that large amounts of EMG data can be easily and objectively processed.     

Immunohistochemical detection of c-erbB-2 and p53 in benign breast disease and breast cancer risk

BACKGROUND: We studied the associations between c-erbB-2 protein overexpression and p53 protein accumulation in benign breast tissue and the risk of subsequent breast cancer. METHODS: We conducted a case-control study nested within the cohort of 4888 women in the National Breast Screening Study (NBSS) who were diagnosed with benign breast disease during active follow-up. Case subjects were the women who subsequently developed breast cancer (ductal carcinoma in situ [DCIS] or invasive carcinoma). Control subjects were matched to each case subject on NBSS study arm, screening center, year of birth, and age at diagnosis of benign breast disease. Histologic sections of benign and cancerous breast tissues were analyzed immunohistochemically. Information on potential confounding factors was obtained by use of a self-administered lifestyle questionnaire. RESULTS: Accumulation of p53 protein was associated with an increased risk of progression to breast cancer (adjusted odds ratio [OR] = 2.55; 95% confidence interval [CI] = 1.01-6.40), whereas c-erbB-2 protein overexpression was not (adjusted OR = 0.65; 95% CI = 0.27-1.53). The findings for c-erbB-2 and p53 did not differ among strata defined by menopausal status, allocation within the NBSS, history of breast disease, and whether the benign breast disease was detected at a scheduled screen or between screens. The results were also similar after exclusion of case subjects whose diagnosis of breast cancer occurred within 1 year of their diagnosis of benign breast disease and after exclusion of subjects with DCIS. CONCLUSIONS: p53 protein accumulation, but not c-erbB-2 protein overexpression, appears to be associated with an increased risk of progression to breast cancer in women with benign breast disease.     

A path analysis of factors associated with distress among first-degree female relatives of women with breast cancer diagnosis.

Patterns and predictors of psychological distress in first-degree female relatives (N = 624) of newly diagnosed breast cancer patients were explored. First-degree female relatives who were high monitors reported greater cancer-specific and general distress than did low monitors. Greater optimism was associated with lower cancer-specific distress. Optimism's effect on general distress was moderated by women's level of monitoring. Greater optimism was associated with lower general distress for both high and low monitors, but the effect was stronger for high monitors than for low monitors. Avoidance and engaged coping were associated with higher distress. A close relationship with the cancer patient was related to higher cancer-specific distress but lower general distress. Further understanding of the process of adjustment in these women awaits longitudinal study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual functioning among breast cancer, gynecologic cancer, and healthy women.

Determined the specific type of sexual functioning deficits and the relationship between global sexual satisfaction and adjustment in 2 related life areas (marital relationship and body image) for 2 groups of cancer patients at high risk for sexual difficulties. The 2 groups included 16 27–67 yr old females with Stage 2 breast cancer and 16 31–65 yr old females with gynecologic cancer. These Ss were compared to 16 healthy female outpatients (controls). Measures included the Sexual Activities scale from the Derogatis Sexual Functioning Inventory, a modified version of the Dyadic Assessment Scale (marital adjustment), a global sexual evaluation, and a body-image scale. Analyses revealed that the aspects of sexual functioning for breast-cancer and gynecologic-cancer Ss that differed from those of controls were the frequency of sexual behaviors and the level of sexual arousal. Whereas Ss' evaluations of their current sexual life had no relationship to their marital-adjustment ratings, analyses suggested that body-image disruption may be a prevalent problem for gynecologic cancer patients. Data suggest that cancer diagnosis and treatment are instrumental in producing reductions in sexual activity and arousability. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diet and breast cancer risk in a cohort of Finnish women

The associations between dietary antioxidant vitamins, dietary fiber, and selected foods and risk of breast cancer were studied in 4697 initially cancer-free women, aged 15 years or older. At baseline (1967-1972) the women were interviewed for total habitual diet over the preceding year. During a 25-year follow-up period 88 breast cancer cases were diagnosed. There was a significant inverse gradient between milk consumption and occurrence of breast cancer, whereas higher consumption of fried meat was associated with increased risk of breast cancer. No significant relationships were found between the intakes of vitamin E, vitamin C, beta-carotene, lycopene, lutein or dietary fiber and the occurrence of breast cancer.     

Marital status, marital satisfaction, and support processes among women at high risk for breast cancer.

This study explored marital status, social support processes, and psychological distress among women at high risk for breast and ovarian cancer who were anticipating genetic testing. In addition to substantive findings, it presents a means of using nonsense coding (J. Cohen & P. Cohen, 1983) to include unmarried persons in regression analyses examining the importance of marital support. These women had mobilized high levels of social support. Married and unmarried women did not differ in distress, but women had to have more satisfying marriages than average to be equivalent to unmarried women. For the married women, husbands were more involved and more influential in decision making than female relatives, even in distressed marriages. Negativity from close relationships, particularly the spouse, had more influence on these women's well-being than did positive involvement. The authors' findings suggest that counseling and education programs need to accommodate the key role that husbands have in decision making concerning genetic testing for risk of breast cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)