While participants in the study of women at higher than normal risk for breast displayed anxiety about all screening tests, their anxiety was highest for the breast self-examination.
It was the only test where compliance was low enough to suggest that anxiety may be a barrier to this screening method. While 79 percent of women went for regular mammograms and 89 percent went for regular Pap smears, only 34 percent of the women performed regular breast self exams.
“Potentially finding disturbing information while alone sets off anxiety that makes this procedure too threatening. This is particularly true for those women that see themselves as more vulnerable to breast cancer,” explain the authors, Nangel M. Lindberg, Ph.D., and David Wellisch, Ph.D., of UCLA School of Medicine’s Department of Psychiatry, in the November issue of Annals of Behavioral Medicine.
The study participants included 430 women recruited at a clinic for women with a family history of breast cancer. The majority of them were white, middle class and well educated.
These patients also identified themselves as being at very high risk for developing breast cancer. This concern may affect their motivation to seek information and help as well as their anxiety level, the investigators say.
“It may be unrealistic and potentially traumatic to direct women with very high self-appraised risk for breast cancer to perform breast self examinations,” the authors say, suggesting that other women may benefit from expanded instruction and support to help them feel more comfortable and adept at performing this home screening procedure.
“Time and again, we hear from these patients ‘I don’t perform breast self-examinations because I would not know what I am feeling,’” Lindberg and Wellisch say in the study. “This underscores the importance of the role health providers play in working on compliance for this screening procedure, and suggests that care should be taken to provide education and support to patients.”
This study, as has previous research, showed that most women highly overestimate their risk of breast cancer.
Nearly 77 percent of the women in this study estimated their breast cancer risk more than 10 percent higher than predicted by a standardized estimate based on several factors such as their age and number of first-degree relatives with breast cancer. Only 5 percent of the women underestimated their risk of breast cancer. They found that women who overestimated their risk also had more general anxiety about screening.
Mammography is a type of X-ray procedure for detecting the earliest visible signs of breast cancer. Pap smears are swab tests that look for cancer cells in the cervix. The breast self-examination is a less accurate method, but may be useful in detect lumps between mammograms. Women at high risk for breast cancer also have an increased risk for cervical cancer.
The study was supported with funds from the California Breast Cancer Research Program of the University of California.
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Annals of Behavioral Medicine