Familial Cancer

, Volume 18, Issue 1, pp 9–18 | Cite as

Reminders of cancer risk and pain catastrophizing: relationships with cancer worry and perceived risk in women with a first-degree relative with breast cancer

  • Colette A. Whitney
  • Caroline S. Dorfman
  • Rebecca A. Shelby
  • Francis J. Keefe
  • Vicky Gandhi
  • Tamara J. SomersEmail author
Original Article


First-degree relatives of women with breast cancer may experience increased worry or perceived risk when faced with reminders of their own cancer risk. Worry and risk reminders may include physical symptoms (e.g., persistent breast pain) and caregiving experiences. Women who engage in pain catastrophizing may be particularly likely to experience increased distress when risk reminders are present. We examined the degree to which persistent breast pain and experience as a cancer caregiver were related to cancer worry and perceived risk in first-degree relatives of women with breast cancer (N = 85) and how catastrophic thoughts about breast pain could impact these relationships. There was a significant interaction between persistent breast pain and pain catastrophizing in predicting cancer worry (p = .03); among women who engaged in pain catastrophizing, cancer worry remained high even in the absence of breast pain. Pain catastrophizing also moderated the relationships between caregiving involvement and cancer worry (p = .003) and perceived risk (p = .03). As the degree of caregiving responsibility increased, cancer worry and perceived risk increased for women who engaged in pain catastrophizing; levels of cancer worry and perceived risk remained low and stable for women who did not engage in pain catastrophizing regardless of caregiving experience. The results suggest that first-degree relatives of breast cancer survivors who engage in pain catastrophizing may experience greater cancer worry and perceived risk and may benefit from interventions aimed at reducing catastrophic thoughts about pain.


Breast cancer First-degree relative Breast pain Caregiving Pain catastrophizing 



This work was supported by a grant from the National Institutes of Health (T32 MH019109).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All human studies have been approved by the Duke University Health System Institutional Review Board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.


  1. 1.
    Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA 67(1):7–30Google Scholar
  2. 2.
    Loescher LJ (2003) Cancer worry in women with hereditary risk factors for breast cancer. Oncol Nurs Forum 30(5):767–772Google Scholar
  3. 3.
    Lerman C, Kash K, Stefanek M, Younger women at increased risk for breast cancer: perceived risk, psychological well-being, and surveillance behavior. J Natl Cancer Inst Monogr 1994(16):171–176Google Scholar
  4. 4.
    Gibbons A, Groarke A (2016) Can risk and illness perceptions predict breast cancer worry in healthy women? J Health Psychol 21(9):2052–2062Google Scholar
  5. 5.
    Pharoah PD et al (1997) Family history and the risk of breast cancer: a systematic review and meta-analysis. Int J Cancer 71(5):800–809Google Scholar
  6. 6.
    Nelson HD et al (2012) Risk factors for breast cancer for women aged 40 to 49 years: a systematic review and meta-analysis. Ann Intern Med 156(9):635–648Google Scholar
  7. 7.
    McPherson K, Steel CM, Dixon JM (2000) ABC of breast diseases. Breast cancer-epidemiology, risk factors, and genetics. BMJ 321(7261):624–628Google Scholar
  8. 8.
    Barlow WE et al (2006) Prospective breast cancer risk prediction model for women undergoing screening mammography. J Natl Cancer Inst 98(17):1204–1214Google Scholar
  9. 9.
    Tracy KA et al (2008) The impact of family history of breast cancer and cancer death on women’s mammography practices and beliefs. Genet Med 10(8):621–625Google Scholar
  10. 10.
    McCaul KD et al (1998) A descriptive study of breast cancer worry. J Behav Med 21(6):565–579Google Scholar
  11. 11.
    Hyman RB et al (1994) Health belief model variables as predictors of screening mammography utilization. J Behav Med 17(4):391–406Google Scholar
  12. 12.
    Kim C et al (2004) Quality of preventive clinical services among caregivers in the health and retirement study. J Gen Intern Med 19(8):875–878Google Scholar
  13. 13.
    Khan SA, Apkarian AV (2002) Mastalgia and breast cancer: a protective association? Cancer Detect Prev 26(3):192–196Google Scholar
  14. 14.
    Kataria K et al (2014) A systematic review of current understanding and management of mastalgia. Indian J Surg 76(3):217–222Google Scholar
  15. 15.
    Ader DN et al (2001) Cyclical mastalgia: prevalence and associated health and behavioral factors. J Psychosom Obstet Gynaecol 22(2):71–76Google Scholar
  16. 16.
    Gilbar O (1998) Coping with threat: implications for women with a family history of breast cancer. Psychosomatics 39(4):329–339Google Scholar
  17. 17.
    Erblich J, Bovbjerg DH, Valdimarsdottir HB (2000) Looking forward and back: distress among women at familial risk for breast cancer. Ann Behav Med 22(1):53–59Google Scholar
  18. 18.
    Romito F et al (2013) Informal caregiving for cancer patients. Cancer 119(Suppl 11):2160–2169Google Scholar
  19. 19.
    Braun M et al (2007) Hidden morbidity in cancer: spouse caregivers. J Clin Oncol 25(30):4829–4834Google Scholar
  20. 20.
    Kim Y, Baker F, Spillers RL (2007) Cancer caregivers’ quality of life: effects of gender, relationship, and appraisal. J Pain Symptom Manag 34(3):294–304Google Scholar
  21. 21.
    Raveis VH, Pretter S (2005) Existential plight of adult daughters following their mother’s breast cancer diagnosis. Psycho-Oncology 14(1):49–60Google Scholar
  22. 22.
    Sullivan MJ et al (2001) Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain 17(1):52–64Google Scholar
  23. 23.
    Sullivan MJ et al (2002) An experimental investigation of the relation between catastrophizing and activity intolerance. Pain 100(1–2):47–53Google Scholar
  24. 24.
    Shelby RA et al (2012) Prospective study of factors predicting adherence to surveillance mammography in women treated for breast cancer. J Clin Oncol 30(8):813–819Google Scholar
  25. 25.
    Asghari A, Nicholas MK (2004) Pain during mammography: the role of coping strategies. Pain 108(1):170–179Google Scholar
  26. 26.
    Whelehan P et al (2013) The effect of mammography pain on repeat participation in breast cancer screening: a systematic review. Breast 22(4):389–394Google Scholar
  27. 27.
    Butler LD et al (2003) Psychological distress and pain significantly increase before death in metastatic breast cancer patients. Psychosom Med 65(3):416–426Google Scholar
  28. 28.
    Perreault A, Fothergill-Bourbonnais F, Fiset V (2004) The experience of family members caring for a dying loved one. Int J Palliat Nurs 10(3):133–143Google Scholar
  29. 29.
    Ferrell B (2001) Pain observed: the experience of pain from the family caregiver’s perspective. Clin Geriatr Med 17(3):595–609Google Scholar
  30. 30.
    Meeker MA, Finnell D, Othman AK (2011) Family caregivers and cancer pain management: a review. J Fam Nurs 17(1):29–60Google Scholar
  31. 31.
    Miaskowski C et al (1997) Differences in mood states, health status, and caregiver strain between family caregivers of oncology outpatients with and without cancer-related pain. J Pain Symptom Manag 13(3):138–147Google Scholar
  32. 32.
    Ovayolu O et al (2015) Pain in cancer patients: pain assessment by patients and family caregivers and problems experienced by caregivers. Support Care Cancer 23(7):1857–1864Google Scholar
  33. 33.
    Botvinick M et al (2005) Viewing facial expressions of pain engages cortical areas involved in the direct experience of pain. Neuroimage 25(1):312–319Google Scholar
  34. 34.
    Jackson PL, Meltzoff AN, Decety J (2005) How do we perceive the pain of others? A window into the neural processes involved in empathy. Neuroimage 24(3):771–779Google Scholar
  35. 35.
    Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1(3):277–299Google Scholar
  36. 36.
    Ferreira VT et al (2015) Characterization of chronic pain in breast cancer survivors using the McGill Pain Questionnaire. J Bodyw Mov Ther 19(4):651–655Google Scholar
  37. 37.
    Sullivan MJL, Bishop S, Pivik J (1995) The Pain Catastrophizing Scale: development and validation. Psychol Assess 7:524–532Google Scholar
  38. 38.
    Osman A et al (1997) Factor structure, reliability, and validity of the Pain Catastrophizing Scale. J Behav Med 20(6):589–605Google Scholar
  39. 39.
    Sullivan MJL, Bishop SR, Pivik J (1995) The Pain Catastrophizing Scale: development and validation. Psychol Assess 7(4):524–532Google Scholar
  40. 40.
    Lerman C et al (1991) Psychological side effects of breast cancer screening. Health Psychol 10(4):259–267Google Scholar
  41. 41.
    Quillin JM et al (2011) Genetic risk, perceived risk, and cancer worry in daughters of breast cancer patients. J Genet Couns 20(2):157–164Google Scholar
  42. 42.
    Mellon S et al. (2008) Risk perception and cancer worries in families at increased risk of familial breast/ovarian cancer. Psychooncology 17(8):756–766Google Scholar
  43. 43.
    Brain K et al (2002) A randomized trial of specialist genetic assessment: psychological impact on women at different levels of familial breast cancer risk. Br J Cancer 86(2):233–238Google Scholar
  44. 44.
    Weinstein ND, Klein WM (1995) Resistance of personal risk perceptions to debiasing interventions. Health Psychol 14(2):132–140Google Scholar
  45. 45.
    Weinstein ND et al (2007) Risk perceptions: assessment and relationship to influenza vaccination. Health Psychol 26(2):146–151Google Scholar
  46. 46.
    Somers TJ et al (2009) Cancer genetics service interest in women with a limited family history of breast cancer. J Genet Couns 18(4):339–349Google Scholar
  47. 47.
    Orom H et al (2013) Perceived risk for breast cancer and its relationship to mammography in Blacks, Hispanics, and Whites. J Behav Med 36(5):466–476Google Scholar
  48. 48.
    Aiken LS, West SG, Reno RR (1991) Multiple regression: testing and interpreting interactions. Sage, Newbury ParkGoogle Scholar
  49. 49.
    Smith RL, Pruthi S, Fitzpatrick LA (2004) Evaluation and management of breast pain. Mayo Clin Proc 79(3):353–372Google Scholar
  50. 50.
    Hashemi-Ghasemabadi M et al (2017) Living under a cloud of threat: the experience of Iranian female caregivers with a first-degree relative with breast cancer. Psycho-Oncology 26(5):625–631Google Scholar
  51. 51.
    Unic I et al (1997) A review on family history of breast cancer: screening and counseling proposals for women with familial (non-hereditary) breast cancer. Patient Educ Couns 32(1–2):117–127Google Scholar
  52. 52.
    Lerman C, Schwartz M (1993) Adherence and psychological adjustment among women at high risk for breast cancer. Breast Cancer Res Treat 28(2):145–155Google Scholar
  53. 53.
    Kash KM et al (1992) Psychological distress and surveillance behaviors of women with a family history of breast cancer. J Natl Cancer Inst 84(1):24–30Google Scholar
  54. 54.
    Audrain-McGovern J, Hughes C, Patterson F (2003) Effecting behavior change: awareness of family history. Am J Prev Med 24(2):183–189Google Scholar
  55. 55.
    Riddle DL et al (2011) Pain coping skills training for patients with elevated pain catastrophizing who are scheduled for knee arthroplasty: a quasi-experimental study. Arch Phys Med Rehabil 92(6):859–865Google Scholar
  56. 56.
    Syrjala KL et al (2014) Psychological and behavioral approaches to cancer pain management. J Clin Oncol 32(16):1703–1711Google Scholar
  57. 57.
    Quartana PJ, Campbell CM, Edwards RR (2009) Pain catastrophizing: a critical review. Expert Rev Neurother 9(5):745–758Google Scholar
  58. 58.
    Keefe FJ, Dunsmore J, Burnett R (1992) Behavioral and cognitive-behavioral approaches to chronic pain: recent advances and future directions. J Consult Clin Psychol 60(4):528–536Google Scholar
  59. 59.
    Bennell KL et al (2017) Effectiveness of an internet-delivered exercise and pain-coping skills training intervention for persons with chronic knee pain: a randomized trial. Ann Intern Med 166(7):453–462Google Scholar
  60. 60.
    Somers TJ et al (2012) Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: a randomized controlled study. Pain 153(6):1199–1209Google Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Colette A. Whitney
    • 1
  • Caroline S. Dorfman
    • 1
  • Rebecca A. Shelby
    • 1
  • Francis J. Keefe
    • 1
  • Vicky Gandhi
    • 1
  • Tamara J. Somers
    • 1
    Email author
  1. 1.Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamUSA

Personalised recommendations