Abstract
Having a family history of cancer is an important predictor of lifetime cancer risk. Individuals with family histories of cancer have been reported to experience symptoms of general distress and to have frequent intrusive thoughts and avoidance regarding cancer. To date, little is known about predictors of such distress. A relation between perception of cancer risk and distress has been suggested, but the possibility that prior cancer-related events may contribute to distress in these women has received little attention. The major aim of the study was to examine the contribution of the past experience of the death of a parent from cancer to distress in women at familiar risk for breast cancer.
Women with family histories of breast cancer (Risk Group, N=46) were assessed on the day of their yearly mammography screening and four to eight weeks after normal result notification in order to confirm the generalizability of their distress. Their levels of intrusive thoughts, avoidance, and perceived lifetime risk for breast cancer were significantly higher than those of women with no family histories of cancer who were not undergoing mammography (Comparison Group, N=43), and this was true on both assessment days. Among the women in the Risk Group, those whose parent (s) had died of cancer had the highest levels of intrusive thoughts, avoidance, and perceived risk. Results suggested that perceived risk mediated the effect of this event on intrusive thoughts and avoidance regarding breast cancer. The findings are discussed in terms of theories of cognitive responses to traumatic and stressful life events. Implications for future research and interventions are discussed.
Similar content being viewed by others
References
Offit K, Brown K: Quantitating familial cancer risk: A resource for clinical oncologists.Journal of Clinical Oncology. 1994,12: 1724–1736.
Wellisch DK, Gritz ER, Schain W, Wang HJ, Siau J: Psychological functioning of daughters of breast cancer patients: Daughters and comparison subject.Psychosomatics. 1991,32: 324–336.
Kash KM, Holland JC, Halper MS, Miller DG: Psychological distress and surveillance behaviors of women with a family history of breast cancer.Journal of the National Cancer Institute. 1992,84: 24–30.
Lerman C, Daly M, Sands C, et al: Mammography adherence and psychological distress among women at risk for breast cancer.Journal of the National Cancer Institute. 1993,85: 1074–1080.
Valdimarsdottir HB, Bovbjerg DH, Kash KM, et al: Psychological distress in women with a familial risk of breast cancer.Psycho-Oncology. 1995,4: 133–141.
Horowitz M, Wilner N, Alvarez W: Impact of Event Scale: A measure of subjective stress.Psychosomatic Medicine. 1979,41: 209–218.
Lerman C, Schwartz M: Adherence and psychological adjustment among women at high risk for breast cancer.Breast Cancer Research and Treatment. 1993,28: 145–155.
Schwartz M, Lerman C, Daly M, etal: Utilization of ovarian cancer screening by women at increased risk.Cancer Epidemiology, Biomarkers & Prevention. 1995,4: 269–273.
Lerman C, Kash K, Stefanek M: Younger women at increased risk for breast cancer: Perceived risk, psychological well-being, and surveillance behavior.Monographs of the National Cancer Institute. 1994,16: 171–176.
Wellisch DK, Gritz ER, Scjaom W, Wang HJ, Siau J: Psychological function of daughters of breast cancer patients: Characterizing the distressed daughter of the breast cancer patient.Psychosomatics. 1992,33: 171–179.
Horowitz MJ, Weiss DS, Kaltreider N, et al: Reactions to the death of a parent. Results from patients and field subjects.Journal of Nervous and Mental Disease. 1984,172: 383.
Horowitz MJ, Marmar C, Weiss DS, DeWitt K, Rosenbaum R: Brief psychotherapy of bereavement reactions.Archives of General Psychiatry. 1984,41: 438–448.
Horowitz MJ, Krupnick J, Kaltreider N, et al: Initial psychological response to parental death.Archives General Psychiatry. 1981,38: 316–323.
Umberson D, Chen MD: Effects of a parent's death on adult children: Relationship salience and reaction to loss.American Sociological Review. 1994,59: 152–168.
Scharlach AE, Fredriksen KI: Reactions to the death of a parent during midlife.Omega. 1993,27: 307–319.
Schwartzberg SS, Janoff-Bulman R: Grief and the search for meaning: Exploring the assumptive worlds of bereaved college students.Journal of Social and Clinical Psychology. 1991,10: 270–288.
Janoff-Bulman R:Shattered Assumptions: Towards a New Psychology of Trauma, New York: Free Press, 1992.
Evans DGR, Brunell LD, Hopwood P, Howell A: Perception of risk in women with a family history of breast cancer.British Journal of Cancer. 1993,67: 612–614.
Easterling DV, Leventhal H: Contribution of concrete cognition to emotion: Neutral symptoms as elicitors of worry about cancer.Journal of Applied Psychology. 1989,74: 787–796.
Derogatis LR, Spencer P:The Brief Symptom Inventory (BSI) Administration Scoring and Procedures Manual-I. Baltimore, MD: 1982.
Gail MH, Brinton LA, Byar DP: Projecting individualized probabilities of developing breast cancer for White females who are being examined annually.Journal of the National Cancer Institute. 1989,81: 1879–1886.
Claus ED, Risch N, Thompson WD: Autosomal dominant inheritance of early-onset breast cancer.Cancer. 1994,73: 643–651.
Horowitz MJ: Stress response syndromes and their treatment. In Goldbert H (ed),Handbook of Stress, New York: Free Press, 1982, 711.
Baron RM, Kenny DA: The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, an statistical considerations.Journal of Personality and Social Psychology. 1986,51: 1173–1182.
Weinstein ND: Unrealistic optimism about future life events.Journal of Personality and Social Psychology. 1980,39: 806–820.
Franklin KM, Janoff-Bulman R, Roberts JE: Long-term impact of parental divorce on optimism and trust: Changes in general assumptions or narrow beliefs?Journal of Personality and Social Psychology. 1990,59: 743–755.
Horowitz MJ:Stress Response Syndromes (2nd Ed.) Northvale, NJ: Jason Aronson Press, 1986.
Janoff-Bulman R: Assumptive worlds and the stress of traumatic events: Applications of the schema construct.Social Cognition. 1989,7: 113–136.
American Psychiatric Association:Diagnostic and Statistical Manual of Mental Disorders, IV, (DSM-IV). Washington, DC: 1994.
Baum A: Stress, intrusive imagery, and chronic distress.Health Psychology. 1990,9: 653–675.
Davidson LM, Baum A: Chronic stress posttraumatic stress disorders.Journal of Consulting and Clinical Psychology. 1986,54: 303–308.
Davidson LM, Baum A: Predictors of chronic stress among Vietnam veterans: Stressor exposure and intrusive recall.Journal of Traumatic Stress. 1993,6: 195.
McFarlane AC, Papay P: Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster.Journal of Nervous and Mental Diseases. 1992,180: 498–504.
Horowitz MJ, Schaefer C, Cooney C:Life event scaling for recency of experience. In Gundersen E, Rahe R (Eds),Life Stress and Illness. Springfield: Thomas, 1974.
Lerman C, Lustbader E, Rimer B, et al: Effects of individualized breast cancer risk counselling: A randomized trial.Journal of the National Cancer Institute. 1995,87: 286–292.
Lerman C, Schwartz MD, Miller SM, et al: A randomized trial of breast cancer risk counselling: Interacting effect of counseling, educational level, and coping style.Health Psychology. 1996,15: 75–83.
Schwartz MD, Lerman C, Audrain J, et al: The impact of a brief problem-solving training intervention for relatives of recently diagnosed breast cancer patients. (in press. 1997).
Author information
Authors and Affiliations
Additional information
Preparation of this manuscript was supported in part by research grants from the American Cancer Society (PBR-92) and the Martell Foundation, as well as a Career Development Award (Valdimarsdottir; J-4139) and a Postdoctoral Fellowship Award (Zakowski; J-4164) from the United States Department of Defense. We are required to indicate that the content of the information contained in this report does not necessarily reflect the position or policy of the United States Government.
The authors want to thank Ms. Jennifer Keats and Julie Fasano for their help in conducting the study, as well as Dr. William Redd and the anonymous reviewers for their comments on an earlier draft of this manuscript.
About this article
Cite this article
Zakowski, S.G., Valdimarsdottir, H.B., Bovbjerg, D.H. et al. Predictors of intrusive thoughts and avoidance in women with family histories of breast cancer. ann. behav. med. 19, 362–369 (1997). https://doi.org/10.1007/BF02895155
Issue Date:
DOI: https://doi.org/10.1007/BF02895155