Anxiety Over Breast Self-Exam = Low Compliance

According to a new study by researchers at UCLA's Jonsson Cancer Center, women who are afraid of what they might find during a breast self-examination are less likely to perform the exams, possibly due to a fear of being alone if they find a lump.

While the study participants-women at higher than normal risk of breast cancer-displayed anxiety about all screening tests, their anxiety was highest for breast self-examination. And breast self-examination was the only test where compliance was low enough to suggest that anxiety may be a barrier to cancer screening.

"The possibility of finding disturbing information while alone sets off anxiety that makes this procedure too threatening," said lead researchers David Wellisch and Nangel Lindberg. "This is particularly true for those women who see themselves as more vulnerable to breast cancer." Their findings were published in the Annals of Behavioral Medicine.

The UCLA researchers found that while 79 percent of the study participants went for regular mammograms and 89 percent went for regular Pap smears (swab tests that look for cancer cells in the cervix), only 34 percent of the women performed regular breast self-exams.

Participants in the UCLA study included 430 women with a family history of breast cancer. They identified themselves as being at very high risk for developing the disease.

"It may be unrealistic and potentially traumatic to direct women with very high self-appraised risk for breast cancer to perform breast self-examinations if these women have difficulty overcoming their anxiety," Wellisch said.

"While women at normal or low risk of breast cancer may benefit from expanded instruction and support to help them feel more comfortable and adept at performing self-examinations, women at high risk who are anxious about self-examinations may benefit more from being advised to receive more frequent clinical breast exams by a health professional."

"Time and again, we hear from high-risk patients, 'I don't perform breast self-examinations because I would not know what I am feeling,' " Wellisch added. "This suggests that care should be taken to provide education and support to patients, especially patients whose anxiety may interfere with their ability to perform self-examination."

The study also indicated that most women highly overestimate their risk of breast cancer, as previous research has shown. More than three quarters of the participants (77 percent) estimated that their risk of breast cancer was at least 10 percent higher than predicted by a standardized algorithm based on age, number of first-degree relatives with breast cancer, and other risk factors. Only 5 percent of the participants underestimated their risk of breast cancer.

SOURCES:
Annals of Behavioral Medicine, November 2001
Jonsson Cancer Center, UCLA

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