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A longitudinal study of factors associated with perceived risk of recurrence in women with ductal carcinoma in situ and early-stage invasive breast cancer

  • Epidemiology
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Abstract

Breast cancer patients’ perceived risk of recurrence has been associated with psychological distress. Little is known about the change of patients’ perceived risk of recurrence over time and factors associated with their recurrence-risk perceptions. We prospectively recruited 549 newly diagnosed early-stage breast cancer patients; patients completed interviews at 6 weeks, 6 months, 1 year, and 2 years after definitive surgical treatment. A random-effects regression model with repeated ordinal measurements was used to estimate the relationship between perceived risk of recurrence and demographic, medical, and psychosocial factors. We analyzed data from 535 patients [34% ductal carcinoma in situ (DCIS); 20% non-white] who reported their perceived risk at one or more interviews. At the first interview, 16% reported having no lifetime risk of recurrence, and another 16% reported ≥50% risk of recurrence, including 15% of DCIS patients. Patients who were white (OR = 5.88, 95% CI 3.39–10.19) and had greater state anxiety (OR = 1.04, 95% CI 1.02–1.07) were more likely, while patients who received radiotherapy (OR = 0.72, 95% CI 0.54–0.96) and had more social support (OR = 0.59, 95% CI 0.46–0.75) were less likely to report higher risk of recurrence. Cancer stage was not significantly associated with perceived risk of recurrence. Perceived risk of recurrence did not change significantly over time. Educating early-stage breast cancer patients about their actual risk could result in more realistic recurrence-risk perceptions, and increasing social support could help alleviate anxiety associated with exaggerated risk perceptions.

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Acknowledgments

This study was supported by a grant from the National Cancer Institute and Breast Cancer Stamp Fund (R01CA102777), and by the National Cancer Institute Cancer Center Support Grant (P30 CA91842) to the Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri. We thank our patient participants, the interviewers, and the Siteman Cancer Center’s Health Behavior and Outreach Core (Ms. Jennifer Tappenden and Dr. Yan Yan) and Biostatistics Core (Dr. Kenneth Schechtman) for data management and statistical services, and Pam Hunborg at Saint Louis University School of Medicine. We also greatly appreciate the many physicians who helped us recruit their patients for this study, including Drs. Barbara Monsees, Jill Dietz, Julie Margenthaler, Virginia Herrmann, Timothy Eberlein, Matthew Ellis, Imran Zoberi, Marie Taylor, Michael Naughton, Antonella Rastelli, Donald Lombardi, Cynthia Ma, Loren Michel, and Rama Suresh at Washington University School of Medicine, and Dr. Eddie Hsueh at Saint Louis University School of Medicine. The Beck Anxiety Inventory ® and BAI ® (copyright 1990, 1993 by Aaron T. Beck) are trademarks of The Psychological Corporation, a Harcourt Assessment Company. The BAI ® was adapted and used by permission of the publisher, The Psychological Corporation. All rights reserved.

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Authors and Affiliations

  1. Division of Health Behavior Research, Department of Internal Medicine, Washington University School of Medicine, 4444 Forest Park, Suite 6700, St. Louis, MO, 63108, USA

    Ying Liu, Maria Pérez, Mario Schootman & Donna B. Jeffe

  2. Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA

    Mario Schootman, Rebecca L. Aft, William E. Gillanders, Matthew J. Ellis & Donna B. Jeffe

  3. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Rebecca L. Aft & William E. Gillanders

  4. John Cochran Veterans Administration Hospital, St. Louis, MO, USA

    Rebecca L. Aft

  5. Division of Medical Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Matthew J. Ellis

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  1. Ying Liu
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Correspondence to Ying Liu.

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Liu, Y., Pérez, M., Schootman, M. et al. A longitudinal study of factors associated with perceived risk of recurrence in women with ductal carcinoma in situ and early-stage invasive breast cancer. Breast Cancer Res Treat 124, 835–844 (2010). https://doi.org/10.1007/s10549-010-0912-1

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