Understanding Reassurance in Women Following Diagnosis of Benign Breast Conditions

Abstract

Undergoing specialist investigation of breast symptoms is a distressing experience for most women because of the possibility of a breast cancer diagnosis. Anxiety is typically reduced in those women who receive a benign diagnosis, however, some women remain distressed and are not reassured, despite malignancy being ruled out. Anxiety following benign breast symptom diagnosis has both clinical and psychological implications. Continuing anxiety may result in further medical consultations and impact negatively on required follow-up assessments and future screening behaviour. This distress can also impinge on women's quality of life and perception of good health. Current psycho-oncology research reflects a limited understanding of why some women are not reassured and the factors detracting from this process. Additionally, it is also unclear what intervention strategies are beneficial to promote reassurance following benign breast symptom diagnosis. Three studies were conducted at "one-stop" specialist breast clinics in Auckland to investigate the psychological impact of benign breast symptom diagnosis. The aim of the first study was to understand who is not reassured following benign diagnosis. A prospective, longitudinal methodology was employed to assess women prior to and immediately following diagnosis and at two and four months. Findings revealed that demographic, clinical, experiential and psychological variables impacted on reassurance in the short and long-term post-benign diagnosis. Specifically, women who were not reassured were more likely to have completed their education at secondary school level. The breast symptoms of a breast lump, breast pain and skin dimpling along with a lower perception of health detracted from reassurance. Women who had a family member and friend with breast cancer were less likely to be reassured as were those with greater fear of treatment, health anxiety and perceived stress. A second study, drawing on cognitive experimental information-processing methodologies, was designed to further understand why some women are not reassured. Women completed a Cancer Stroop task and ambiguous words task to investigate the role of attention and selective interpretation biases in the context of benign diagnosis. Findings suggest that biases may be operating for non-reassured women and that specific factors may play a role in anxiety following benign diagnosis. Women who were not reassured showed a greater attention and interpretive bias towards negative/threatening information. Additionally, results indicate that the Stroop task may be uncovering anxiety that is not evident in traditional self-report measures, as women who rated they were reassured experienced greater interference for cancer and threat words compared to not reassured women. The aim of the third study was to develop intervention strategies for women undergoing breast symptom diagnosis to reduce anxiety and enhance reassurance for benign symptoms. Women were randomly assigned prior to attending the clinic to one of three groups: standard clinic information, an additional information pamphlet or an additional pamphlet and meeting with a psychologist following benign diagnosis. Although the women receiving the additional pamphlet reported that they found the additional information helpful and made the process less threatening, no differences in anxiety were found across the groups prior to diagnosis. At follow-up, the effects of the additional pamphlet or support from the psychologist were not evident as no differences in levels of reassurance and anxiety were found. Taken together these studies support and extend current knowledge of the psychological impact of benign breast symptom diagnosis. Although further work is needed to clarify effective intervention strategies for women undergoing specialist assessment, this research contributes towards building a picture of women at risk for non-reassurance following benign breast symptom diagnosis. The findings also provide important clinical implications for health professionals working with women attending specialist breast clinics.