title: A longitudinal study of factors associated with perceived risk of recurrence in women with ductal carcinoma in situ and early-stage invasive breast cancer.
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.
authors.affiliation: Division of Health Behavior Research, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63108, USA. liuyi@wudosis.wustl.edu
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.forename: Maria
authors.initials: M
authors.lastname: Pérez
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Aft
authors.forename: William E
authors.initials: WE
authors.lastname: Gillanders
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Ellis
authors.forename: Donna B
authors.initials: DB
authors.lastname: Jeffe
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001943:Breast Neoplasms / Q000208:ethnology / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000208:ethnology / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008408:Mastectomy; D008875:Middle Aged; D008923:Missouri; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000208:ethnology / Q000473:pathology / Q000523:psychology*; D009367:Neoplasm Staging; D016017:Odds Ratio; D010353:Patient Education as Topic; D010465:Perception; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012944:Social Support; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D044465:White People / Q000523:psychology
references.citation: Annu Rev Public Health. 1993;14:43-68
references.pmid: 8323597
references.citation: J Surg Res. 2009 May 1;153(1):105-13
references.pmid: 19084242
references.citation: Cancer. 1988 Sep 15;62(6):1231-7
references.pmid: 3044575
references.citation: Am J Epidemiol. 1988 Mar;127(3):684-90
references.pmid: 3257643
references.citation: J Clin Oncol. 2007 Oct 1;25(28):4438-44
references.pmid: 17785707
references.citation: J Clin Oncol. 1993 Apr;11(4):783-93
references.pmid: 8478672
references.citation: Cancer Epidemiol Biomarkers Prev. 2007 Feb;16(2):244-8
references.pmid: 17301256
references.citation: CA Cancer J Clin. 1997 May-Jun;47(3):150-3
references.pmid: 9152172
references.citation: Cancer. 2001 Jan 15;91(2):443-54
references.pmid: 11180093
references.citation: Cancer. 1995 Jan 1;75(1):54-64
references.pmid: 7804978
references.citation: CA Cancer J Clin. 2002 Sep-Oct;52(5):256-76
references.pmid: 12363325
references.citation: Addiction. 2000 Nov;95 Suppl 3:S381-94
references.pmid: 11132364
references.citation: N Engl J Med. 1993 Jun 3;328(22):1581-6
references.pmid: 8292119
references.citation: Psychooncology. 2005 Jun;14(6):503-9
references.pmid: 15390218
references.citation: Cancer Epidemiol Biomarkers Prev. 2006 Oct;15(10):1893-8
references.pmid: 17035396
references.citation: Behav Res Methods Instrum Comput. 2002 May;34(2):151-7
references.pmid: 12109005
references.citation: Womens Health. 1997 Fall-Winter;3(3-4):227-42
references.pmid: 9426495
references.citation: Lancet. 2005 May 14-20;365(9472):1687-717
references.pmid: 15894097
references.citation: Cancer Epidemiol Biomarkers Prev. 2010 Mar;19(3):746-54
references.pmid: 20160278
references.citation: J Clin Oncol. 2001 Apr 15;19(8):2263-71
references.pmid: 11304780
references.citation: J Consult Clin Psychol. 2000 Dec;68(6):965-75
references.pmid: 11142549
references.citation: N Engl J Med. 2002 Oct 17;347(16):1233-41
references.pmid: 12393820
references.citation: Med Care. 1996 Jan;34(1):73-84
references.pmid: 8551813
references.citation: Eur J Cancer. 2007 Feb;43(3):549-56
references.pmid: 17140788
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: J Womens Health Gend Based Med. 2001 Jul-Aug;10(6):589-98
references.pmid: 11559456
references.citation: Prev Med. 2004 Jul;39(1):64-73
references.pmid: 15207987
references.citation: J Natl Cancer Inst. 2008 Feb 20;100(4):243-51
references.pmid: 18270338
references.citation: J Consult Clin Psychol. 1988 Dec;56(6):893-7
references.pmid: 3204199
references.citation: Breast Cancer Res Treat. 1993 Nov;28(2):145-55
references.pmid: 8173067
references.citation: N Engl J Med. 2001 Nov 8;345(19):1378-87
references.pmid: 11794170
references.citation: J Clin Oncol. 2001 Mar 15;19(6):1688-97
references.pmid: 11250998
references.citation: Breast Cancer Res Treat. 1996;40(1):25-35
references.pmid: 8888150
references.citation: Breast Cancer Res Treat. 2003 Feb;77(3):285-93
references.pmid: 12602928
references.citation: Cancer Nurs. 1996 Jun;19(3):162-9
references.pmid: 8674024
references.citation: Am J Epidemiol. 2004 Feb 15;159(4):364-72
references.pmid: 14769640
references.citation: Eur J Cancer. 1995;31A(9):1425-7
references.pmid: 7577065
references.citation: Psychosom Med. 1999 Mar-Apr;61(2):181-7
references.pmid: 10204971
references.citation: Cancer Epidemiol Biomarkers Prev. 1994 Apr-May;3(3):253-9
references.pmid: 8019376
references.citation: J Health Psychol. 2007 Jan;12(1):53-65
references.pmid: 17158840
references.citation: Palliat Support Care. 2007 Mar;5(1):61-9
references.pmid: 17461372
references.citation: Radiat Oncol. 2007 Aug 02;2:28
references.pmid: 17683529
references.citation: Soc Sci Med. 1991;32(6):705-14
references.pmid: 2035047
references.citation: Ann Behav Med. 1999 Summer;21(3):201-9
references.pmid: 10626025
references.citation: Cancer. 2008 Nov 1;113(9):2565-74
references.pmid: 18816610
references.citation: Med Care. 2000 Mar;38(3):281-9
references.pmid: 10718353
references.citation: Am J Psychiatry. 1983 Jun;140(6):734-9
references.pmid: 6846631
references.citation: Am J Surg. 2000 Jan;179(1):22-6
references.pmid: 10737572
references.citation: Cancer Epidemiol Biomarkers Prev. 1998 Aug;7(8):689-96
references.pmid: 9718221
references.citation: Cancer Epidemiol Biomarkers Prev. 2004 Dec;13(12):2096-105
references.pmid: 15598767