Oh no, not this again

Breast cancer survivors more distressed by mammograms

By Owen Dyer

Women who have survived breast cancer may be avoiding screening because they find it too stressful. A survey of 135 women undergoing mammography in Toronto found that those with a previous history of the disease reported two to four times as many acute stress symptoms as women with no previous cancer. The research is published in the current issue of the journal Psychosomatic Medicine.

"This raises the question of why women may be reluctant to undergo regular follow-up mammograms, " said lead author Dr Maria Gurevich of Toronto's Ryerson University and Princess Margaret Hospital.

Of the 135 women assessed at a large cancer centre in Toronto, 66 women had survived breast cancer while the other 69 women never had the disease. None of the women were found to have cancer during their screening. The patients answered questions about stress levels, trauma history, psychiatric history, social support and physician support.

The cancer survivors had all received treatment at least one year previously and on average were 6.5 years past their initial diagnosis. Yet these cancer survivors scored even higher on tests of acute stress than women who were newly diagnosed with breast cancer scored in a previous study, said Dr Gurevich.

"Survivors of breast cancer may experience heightened cancer-related fears, even after they have received negative mammography results, " she said. "Our study suggests that perhaps the experience triggers distressing memories of prior cancers. The experience of previous cancer may have a persistent influence on health-related threats and events even in the absence of recurring disease. "

Other triggers for stress identified in the study included pre-mammography breast complaints, lower income, previous psychiatric medication use and greater sensitivity to physical sensations not related to illness.

While greater physician support appeared to lower stress in women undergoing mammography who had never had cancer, among the breast cancer survivors strong support from a physician was actually associated with higher stress levels. But Dr Gurevich thinks this is simply because patients who were already distressed drew extra attention from their doctors.