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Stress Response Syndromes in Women Undergoing Mammography: A Comparison of Women With and Without a History of Breast Cancer

Psychosocial Oncology and Palliative Care Program (M.G., G.M.D., G.M.R.) and Surgical Oncology (D.M.), Princess Margaret Hospital, and Medical Imaging (C.W.), University Health Network; Department of Psychology (M.G.), Ryerson University; and Department of Psychiatry (G.M.D., G.M.R.), University of Toronto, Toronto, Canada; and Department of Psychiatry (C.R.M.), University of California and Department of Veterans Affairs Medical Center, San Francisco, CA.

Address correspondence and reprint requests to Maria Gurevich, PhD, Assistant Professor, Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada. E-mail: mgurevic{at}ryerson.ca

OBJECTIVE: The purpose of this study was to assess the incidence, severity, and correlates of acute stress responses in women undergoing diagnostic mammographic surveillance and to explore the moderating impact of physician support on these symptoms.

METHODS: Sixty-six female breast cancer outpatients (at least 12 months after diagnosis and primary treatment) and 69 healthy women undergoing mammographic surveillance completed measures of: acute stress response, somatization, trauma history, psychiatric history, social support, and physician satisfaction.

RESULTS: Previous cancer, pre-mammography breast complaints, lower income, previous psychiatric medication use, greater instrumental support, greater somatization, greater perceived physician disengagement, and less perceived physician support were all associated with increased stress responses. Among women with a previous cancer diagnosis, those with greater distress reported higher levels of physician support. In contrast, among those without a previous cancer diagnosis, those with greater perceived physician support reported less distress.

CONCLUSIONS: These findings suggest that cancer-related cues, such as follow-up surveillance, may trigger a sensitizing response in women with a previous cancer diagnosis. The association of distress with physician support may arise from the responsiveness of physicians to identified distress, from increased help-seeking behavior by those who are distressed, or both. The benefit of support provided by health care professionals to those at risk of developing stress response syndromes deserves further study.

Key Words: diagnostic mammographic surveillance, • breast cancer, • stress response syndromes.

Abbreviations: ASD = acute stress disorder;; MDSS = physician disengagement;; MR = multiple regression;; PMH = Princess Margaret Hospital;; PSQ-MD = Patient Satisfaction With Doctor Questionnaire;; PSSS = perceived support;; PTSD = posttraumatic stress disorder;; SASRQ = Stanford Acute Stress Reaction Questionnaire;; SNSA = Social Network and Support Assessment;; SSAS = Somatosensory Amplification Scale;; THQ = Trauma History Questionnaire.

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