Anxiety over breast self-examination may lead to low compliance, UCLA researchers find

November 09, 2001

Women who are afraid of what they might find during a self-examination for breast lumps are less likely to perform the exams, possibly due to a fear of being alone when they find a lump, according to a new study by researchers at UCLA.

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. This is particularly true for those women who see themselves as more vulnerable to breast cancer," said the study's authors, David Wellisch, a psychologist, professor in UCLA's Department of Psychiatry & Biobehavioral Sciences and a member of UCLA's Jonsson Cancer Center, and Nangel Lindberg, a former postdoctoral fellow in the Department of Psychiatry & Biobehavioral Sciences.

The findings are published in the November issue of Annals of Behavioral Medicine, the official, peer-reviewed publication of the Society 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.

Compared to mammography, a type of X-ray procedure used to detect breast cancer, breast self-examination is a less accurate cancer detection method, but it can be useful in detecting lumps between mammograms.

Women at high risk of breast cancer also have an increased risk of cervical cancer.

Participants in the UCLA study 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 of developing breast cancer. This concern may affect their motivation to seek information and help as well as their anxiety level, Wellisch said.

"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 said. "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, 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.

For nearly 77 percent of the participants, their own estimations of breast cancer risk were 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 participants underestimated their risk of breast cancer. Researchers found that women who overestimated their risk also had more general anxiety about screening.

University of California - Los Angeles

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