Moderate/severe Depression (MADRS) Can Affect the Quality of Life and Outcome Among Patients Admitted to Breast Cancer Diagnosis Unit.

AIM: The Montgomery-Asberg Depression Rating Scale (MADRS) is one of the most widely used examiner rating instruments for screening, diagnosis and measuring the severity of depression. However, the long-term predictive value of the MADRS in patients admitted to the breast cancer diagnosis unit (BCDU) is unknown. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study women with breast symptoms were evaluated for the total MADRS score before any diagnostic procedures. The relapse-free survival (RFS) was calculated from the time of diagnosis to the time of first relapse including local relapse, contralateral breast cancer (BC) or metastatic disease. The overall survival (OS) was assessed as the time from the date of diagnosis to the date of last follow-up or death of the patient. The effect of the MADRS on the RFS and on the OS were calculated by Kaplan-Meier survival analysis and the difference between groups was assessed by the log-rank test. The RFS and OS were estimated for the study groups with the low MADRS score (<25) versus the high MADRS score (≥25). The end-point of our study was to determine differences in long-term outcome and in MADRS score in breast cancer (BC), benign breast disease (BBD) and healthy study subjects (HSS). RESULTS: In the Cox proportional hazard model the total MADRS score significantly predicted the 25 year RFS and OS in the HSS, BBD and BC groups combined (HR=2.26, p=0.006; HR=2.46, p=0.008, respectively), and in the Kaplan-Meier survival analysis with the log-rank test the total MADRS score predicted the 25 year RFS and OS in the HSS, BBD and BC groups combined (p=0.005; p=0.006, respectively). CONCLUSION: The moderate/severe depression (MADRS) can affect the quality of life and outcome among patients admitted to the BCDU.

Beck Depression Inventory as a Predictor of Long-term Outcome Among Patients Admitted to the Breast Cancer Diagnosis Unit: A 25-year Cohort Study in Finland.

AIM: The Beck Depression Inventory (BDI) is one of the most widely used instruments for measuring the severity of depression. However, there has been no prospective study to investigate the long-term outcome in patients admitted to Breast Cancer Diagnosis Units. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study, women with breast symptoms were evaluated for total BDI score before any diagnostic procedures were carried out. The relapse-free survival (RFS) was calculated from the time of diagnosis to the time of first relapse including local relapse, contralateral breast cancer (BC) or metastatic disease. The overall survival (OS) was assessed as the time from the date of diagnosis to the date of last follow-up or death of the patient. The effect of the BDI on the RFS and on the OS were calculated by the Kaplan-Meier survival analysis and the difference between the groups was assessed by the log-rank test. The RFS and OS was estimated for the study groups with a low BDI score (<8) versus those with a high BDI score (≥8). The end-point of our study was to determine differences in long-term outcome and in BDI score in individuals with BC, benign breast disease (BBD) and in healthy study subjects (HSS). RESULTS: In the Cox proportional hazard model, the total BDI score significantly predicted the 25-year RFS and OS in the HSS, BBD and BC groups combined (Hazard Ratio=1.87, p=0.039; Hazard Ratio=1.98, p=0.048, respectively), and in the Kaplan-Meier survival analysis with the log-rank test, the total BDI score predicted the 25-year RFS and OS in the HSS, BBD and BC groups combined (p=0.043; p=0.036, respectively). CONCLUSION: The BDI is a significant predictor of long-term outcome among patients admitted to the Breast Cancer Diagnosis Unit in Finland.

Suicidal Ideation Versus Hopelessness/Helplessness in Healthy Individuals and in Patients with Benign Breast Disease and Breast Cancer: A Prospective Case-control Study in Finland.

BACKGROUND/AIM: The relation between suicidal ideation versus hopelessness/helplessness in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC) has not been compared to date in a prospective study. We, therefore, investigated suicidal ideation versus hopelessness/helplessness in 115 patients. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated for hopelessness and helplessness versus suicidal/pessimistic thoughts before any diagnostic procedures were carried-out. RESULTS: In the self-rating score (SRS), hopelessness and the helplessness versus pessimistic thoughts were significantly correlated in the HSS, BBD and BC groups. In the SRS, the weighted kappa-values for hopelessness versus pessimistic thoughts in the BBD group were also statistically significant. There was also a significant positive correlation in the examiner-rating score (ERS) in the hopelessness versus pessimistic thoughts in the HSS, BBD and BC groups, as well as in the ERS, in the helplessness versus pessimistic thoughts in the HSS and BBD groups. In SRS, the hopelessness and the helplessness versus suicidal thoughts were significantly correlated in the HSS, BBD and BC groups. There was also a significant positive correlation in the ERS in the hopelessness versus suicidal thoughts in the HSS, BBD and BC groups, as well as in the ERS, in the helplessness versus suicidal thoughts in the BBD group. CONCLUSION: A new finding with clinical relevance in the present work is the agreement between hopelessness/helplessness versus suicidal/pessimistic thoughts in the self-rating and examiner-rating. In the breast cancer diagnostic Unit, the identification of suicidal ideation is essential in suicide prevention and it is important to assess and treat depression even though a subject reports little suicidal ideation.

Agreement between hopelessness/helplessness and Montgomery-Asberg Depression Rating Scale in healthy individuals and in patients with benign breast disease and breast cancer: a prospective case-control study in Finland.

BACKGROUND: The relation between scoring for hopelessness/helplessness and the Montgomery-Asberg Depression Rating Scale (MADRS) in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC) has not been compared in a prospective study. We, therefore, investigated hopelessness and helplessness scores versus the MADRS in 115 patients. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated for hopelessness and helplessness, and for the MADRS before any diagnostic procedures were carried out. RESULTS: In the self-rating score (SRS), hopelessness/helplessness versus the MADRS were highly significantly positively correlated in the HSS, BBD and BC groups. In the SRS, the weighted kappa values for hopelessness/helplessness versus the MADRS in the HSS, BBD and BC groups were also statistically significant. There was also a significant positive correlation in the examiner-rating score (ERS) for hopelessness versus the MADRS in the HSS, BBD and BC groups and for helplessness versus the MADRS in the HSS, BBD and BC groups. The unweighted kappa values in the ERS for hopelessness versus the MADRS were statistically highly significant for the HSS, BBD and BC groups and those for helplessness versus the MADRS in the HSS and BBD groups were statistically significant. CONCLUSION: A new finding with clinical relevance in the present work is the agreement between hopelessness/helplessness scores and MADRS in the SRS and ERS. In the breast cancer diagnostic unit, the identification of hopeless/helpless persons is essential in suicide prevention and it is important to assess and treat hopelessness/helplessness even though an individual may report few depressive symptoms.

Emotional personality/proximity versus emotional authenticity in patient-physician communication in healthy study participants, and in patients with benign breast disease, and breast cancer: a prospective case-control study in Finland.

BACKGROUND/AIM: The associations between emotional personality, proximity and authenticity in patient-physician communication during breast cancer (BC) consultations are rarely considered together in a prospective study. We, therefore, investigated emotional personality/proximity versus authenticity in patient-physician communication in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC). PATIENTS AND METHODS: In the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated regarding emotional personality, proximity and authenticity in their a patient-physician communication before any diagnostic procedures were carried-out. RESULTS: The emotional personality and the emotional proximity in patient-physician communication was highly significantly positively correlated in the BBD group. The kappa-values for emotional personality versus emotional proximity in the HSS, BBD and BC groups were statistically significant. There was also a highly significant positive correlation between emotional personality and emotional authenticity in the HSS, BBD and BC groups and the kappa values in the HSS, BBD and BC groups were statistically significant. There was a highly significant positive correlation between emotional proximity and emotional authenticity in the BBD group, and the weighted kappa-values in the BBD group were statistically significant. CONCLUSION: The results of the present study support a powerful link between emotional personality/proximity and emotional authenticity, and provides new information in patient-physician communication in the HSS, BBD and BC groups. This finding is of clinical importance, since during breast disease consultation, barriers to patient-physician communication may be associated with difficulties in early BC diagnosis in the breast cancer diagnostic unit.

The relation of hopelessness/helplessness versus beck depression inventory (BDI) in healthy individuals and in patients with benign breast disease and breast cancer: a prospective case-control study in Finland.

BACKGROUND/AIM: The relation between hopelessness/helplessness versus the Beck Depression Inventory (BDI) in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC) has not been compared in a prospective study before. We, therefore, investigated hopelessness and helplessness versus the BDI in 115 patients. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated for hopelessness and helplessness versus the BDI before any diagnostic procedures were carried out. RESULTS: In the self-rating score (SRS), the hopelessness and the helplessness versus the BDI were highly significantly positively correlated in the HSS, BBD and BC groups. In the SRS, the weighted kappa values for hopelessness and helplessness versus the BDI in the HSS, BBD and BC groups were also statistically significant. There was also a significant positive correlation in the examiner-rating score (ERS) in the hopelessness versus the BDI in the BBD and BC groups and in the ERS in helplessness versus the BDI in the HSS and BBD groups. The unweighted kappa values in the ERS for hopelessness versus the BDI in the HSS and BBD groups were statistically highly significant and the unweighted kappa values in the ERS for helplessness versus the BDI in the BBD and BC groups were statistically significant. CONCLUSION: The results of this study support a powerful link between hopelessness and helplessness versus BDI in the self-rating and examiner-rating. This finding is of clinical importance since, in the breast cancer diagnostic unit, the patients with hopelessness/helplessness characteristics and high BDI score might be associated with a difficulty and delay in reaching BC diagnosis.

The self-rating score (SRS) versus the examiner rating score (ERS) in measuring helplessness in healthy individuals and in patients with benign breast disease and breast cancer: a prospective case-control study in Finland.

BACKGROUND: The self-rating score (SRS) versus examiner rating score (ERS) in measuring helplessness in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC) has not been yet compared in a prospective study. We, therefore, investigated SRS versus ERS in 115 patients. PATIENTS AND METHODS: In an extension of the Kuopio Breast Cancer Study 115 women with breast symptoms were evaluated for hopelessness versus helplessness before any diagnostic procedures were carried-out. RESULTS: The SRS and the ERS for hopelessness were highly significantly positively correlated in the HSS, BBD and BC groups. The weighted kappa values for hopelessness between the SRS and the ERS in the HSS, BBD and BC groups were also statistically significant. There was also a significant positive correlation between the SRS and the ERS for helplessness in the HSS, BBD and BC groups. The weighted and unweighted kappa-values for hopelessness versus helplessness for the SRS in the HSS, BBD and BC groups were statistically significant. The Spearman correlation coefficients and both weighted and unweighted kappa values for hopelessness versus helplessness in the ERS in the HSS, BBD and BC groups were statistically significant. CONCLUSION: The results of this study support a specific link between hopelessness and helplessness attitude characteristics by SRS and ERS. This finding is of clinical importance, since in the BC and BBD groups, hopelessness/helplessness might be associated with a delay in BC diagnosis and have a negative impact on the adjustment and well-being of patients.

Contribution of emotional distance and reserve in patient-physician communication in healthy study patients, and in patients with benign breast disease and breast cancer: a prospective case-control study in Finland.

AIM: Emotionally-restricted and 'poor-understanding'communication between a patient and their physician may be associated with difficulties in diagnosis and with poor treatment results in clinical practice. To our knowledge, the associations between distance and reserve in patient-physician communication and the risk of breast cancer (BC) are rarely considered together in a prospective study. PATIENTS AND METHODS: In an extension of the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated for emotional distance and reservation in patient-physician communication before any diagnostic procedures were carried out. RESULTS: Clinical examination and biopsy showed BC in 34 patients, benign breast disease (BBD) in 53 patients, while 28 individuals were shown to be healthy (HSS). There was a trend for the BC group to report more emotional distance in patient-physician communication (30/34, 89.0%; grade I to IV emotional distance) than the patients in the HSS and BBD groups (78.6% and 75.5%, grade I to IV emotional distance, respectively). However, the mean of the distance score for HSS, BBD and BC groups differed only slightly in grade II and grade III. The BC group had a higher ERS emotional reservation score in contact (25/34, 73.5%; grade I to IV reserve) than the patients in the HSS and BBD groups (57.1% and 62.1%, grade I to IV reserve, respectively). However, the mean of the reserve score for HSS, BBD and BC groups differed only slightly in grade II, grade III and grade IV. CONCLUSION: The results of this study showed that patients with BC could be at risk for emotional distance and reserve in patient-physician communication and this should be taken into account in the relationship between the patient and their physician and may have clinical relevance in day-to-day clinical work.

Assessment of 'cancer-prone personality' characteristics in healthy study subjects and in patients with breast disease and breast cancer using the commitment questionnaire: a prospective case-control study in Finland.

BACKGROUND: The findings of a repressed expression of emotions in cancer patients contributed to the hypothesis developed by Lydia Temoshok of a type C personality ('cancer-prone'). To the Authors' knowledge, the associations between the 'cancer-prone personality' characteristics in commitment test and the risk of breast cancer (BC) have rarely been considered together in a prospective study. PATIENTS AND METHODS: In an extension of the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated for commitment test before any diagnostic procedures were carried out. RESULTS: The clinical examination and biopsy showed BC in 34 patients, benign breast disease (BBD) in 53 patients and 28 individuals were shown to be healthy study subjects (HSS). The BC group reported significantly more commitment to own children (Function A) (mean Commitment score, 3.14) than the patients in the BBD group (mean Commitment score, 3.51) and in the HSS group (mean Commitment score, 3.77) (p=0.05). The women in the BC group also reported more commitment to own husband (Function B) (mean Commitment score, 3.30) than the patients in the BBD group (mean Commitment score, 3.83) and the patients in the HSS group (mean Commitment score, 3.76). The BC group reported significantly more commitment to own work and own body (Function D and G) (mean Commitment scores, 3.20 and 3.50) than the patients in the BBD group (mean Commitment scores, 3.75 and 3.71) or HSS group (mean Commitment scores, 3.46 and 3.50). The mean sum (mean, SD) of the scores were significantly lower in the BC group (31.1, 5.8) than in the BBD (35.2, 6.9) and HSS group (36.4, 5.6) (p=0.02), showing more commitment in the BC group. CONCLUSION: In summary, patients with BC tended to have an increased risk for bearing the 'high commitment' characteristic and this pattern could contribute to cancer risk through immune and hormonal pathways.

Measurement of pessimism: hopelessness scale in healthy study subjects, and in patients with benign breast disease and breast cancer: a prospective case-control study in Finland.

BACKGROUND: A hopeful attitude is important for psychological well being, and hopelessness is associated with various chronic illnesses, including cancer. To the Authors' knowledge, the associations between hopelessness and the risk of breast cancer (BC) are rarely considered together in a prospective study. MATERIALS AND METHODS: In an extension of the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated for hopelessness before any diagnostic procedures were carried out. RESULTS: The clinical examination and biopsy showed BC in 34 patients, benign breast disease (BBD) in 53 patients, while 28 individuals were shown to be healthy study subjects (HSS). There was a trend for the BBD and BC group to report clearer hopelessness (18.9% and 20.6%, grade III hopelessness, respectively) than the patients in the HSS group (10.7%, grade III hopelessness). However, the mean sum of the hopelessness score for HSS, BBD and BC groups differed only slightly in other grades. There was a trend for the HSS, BBD and BC groups to 'understage' hopelessness. In the HSS group, no study subjects who reported grade III/IV hopelessness by the self-rating method (SRM) vs. 4/28 (14.3%) subjects of the HSS group reported grade III/IV hopelessness by the examiners rating method (ERM). In the BBD group 7/53 (13.2%) subjects reported grade III/IV hopelessness by the SRM vs. 12/53 (22.7%) subjects of the BBD group by the ERM. In the BC group, 2/34 (5.9%) subjects reported grade III/IV hopelessness by SRM vs. 8/34 (23.5%) subjects of the BC group by the ERM. CONCLUSION: The results of this study show that patients with BC and BBD are at risk for hopelessness.

Sifneos alexithymia questionnaire in assessment of general alexithymia in patients with breast disease and breast cancer: a prospective case-control study in Finland.

BACKGROUND: In 1973, Sifneos introduced the word 'alexithymia' to describe the inability to find appropriate words to describe one's feelings. To the Authors' knowledge, the associations between alexithymia and the risk of breast cancer (BC) are rarely considered together in a prospective study. PATIENTS AND METHODS: In an extension of the Kuopio Breast Cancer Study 115 women with breast symptoms were semi-structurally interviewed in-depth, as well as being asked to complete standardised questionnaires (Beck, Forsen, MADRS, Spielberger), and all study variables were obtained before any diagnostic procedures were carried out. The investigator estimated the alexithymia of the study participants using a 5-point scale. RESULTS: The clinical examination and biopsy showed BC in 34 patients, benign breast disease (BBD) in 53 patients, and 28 individuals were shown to be healthy (HSS). There was a significance for the women with BC to have more alienation from own body (Function C, p=0.03) (mean Alexithymia score, 2.82) than those of the BBD (mean Alexithymia score, 3.40) and HSS groups (mean Alexithymia score, 3.29). The BC group had significantly more alienation from own experience (Function D, p=0.01) (mean Alexithymia score, 2.82) than the patients in the BBD group (mean Alexithymia score, 3.51) and in the HSS group (mean Alexithymia score, 3.36). The BC group also had more alienation from own feelings (Function E, p=0.05) and more deficit in self-experience (Function F, p=0.05) than the patients in the BBD group and the patients in the HSS group. CONCLUSION: The results of this study show that the patients with BC tended to have an increased risk for alexithymia.

Assessment of general anxiety in patients with breast disease and breast cancer using the Spielberger STAI self evaluation test: a prospective case-control study in Finland.

BACKGROUND: Trait anxiety (T-Anxiety) was assessed using the subscale from the Spielberger State-Trait Anxiety Inventory test (STAI form Y-2), with statements refering to how a person generally feels, and a higher total score reflecting a higher T-Anxiety. To the authors' knowledge, the associations between the STAI test and the risk of breast cancer (BC) are rarely considered together in a prospective study. PATIENTS AND METHODS: In an extension of the Kuopio Breast Cancer Study 115 women with breast symptoms were evaluated for anxiety using the STAI form Y-2 test before any diagnostic procedures were carried out. RESULTS: The clinical examination and biopsy showed BC in 34 patients, benign breast disease (BBD) in 53 patients and 28 individuals were shown to be healthy study subjects (HSS). There was a trend for the HSS women to have less severe anxiety in the STAI test (1/28 patients, 3.6%) than those in the BBD (7/53 patients, 13.2%) and BC groups (4/34 patients, 11.8%). The subjects in the HSS group reported being significantly more happy in the STAI test (STAI mean score, 1.54) than the BBD group (STAI mean score, 1.98) and the BC group (STAI mean score, 2.00) (p=0.01). The subjects in the HSS group also reported being more content in the STAI test (STAI mean score, 1.68) than the BBD group (STAI mean score, 1.87) and the BC group (STAI mean score, 1.97). CONCLUSION: Patients with BC and BBD tend to have more unhappy and uncontent feelings, but no specific link between the STAI test (form Y-2) and breast cancer risk is supported.

Montgomery-Asberg Depression Rating Scale (MADRS) in healthy study subjects, in patients with breast disease and breast cancer: a prospective case-control study.

BACKGROUND: In 1979, Montgomery and Asberg introduced an inventory for screening of depression. To our knowledge, the associations between the MADRS and the risk of breast cancer (BC) are rarely considered together in a prospective study. PATIENTS AND METHODS: In an extension of the Kuopio Breast Cancer Study, 115 women with breast symptoms were semi-structurally interviewed in-depth, as well as asked to complete standardised questionnaires (BDI, Forsen, Spielberger), and all study variables were obtained before any diagnostic procedures were carried out. MADRS was used to evaluate the depression of the study participants. RESULTS: The clinical examination and biopsy showed BC in 34 patients, benign breast disease (BBD) in 53 patients, and 28 individuals were shown to be healthy (HSS). There was a trend for the women of the HSS group to have less apparent sadness (MADRS mean score, 1.14) than these of the BC (MADRS mean score, 1.47) and BBD groups (MADRS mean score, 1.66). The HSS group tended to have less inner tension and less lassitude (MADRS mean score, 0.93 and 0.50) than the patients in the BC group (MADRS mean score, 1.24 and 1.18) and in the BBD group (MADRS mean score, 1.13 and 1.28). The HSS group also reported less inability to feel (MADRS mean score, 1.14) than the patients in the BC group (MADRS mean score, 1.41) and the patients in the BBD group (MADRS mean score, 1.28). The mean sum of the scores of MADRS variables were significantly lower in the HSS group (MADRS mean score, 8.43) than in the BC (MADRS mean score, 11.35) and BBD groups (MADRS mean score, 10.68). CONCLUSION: The results of this study do not support a specific link between MADRS and breast cancer risk. However, patients with BC or BBD tended to have an increased risk for experiencing depressive symptoms.

Forsen psychological risk inventory for breast cancer patients: a prospective case-control study with special reference to the use of psychiatric medications.

BACKGROUND: In 1989, Forsen introduced an inventory for psychological identification of breast cancer (BC) patients before biopsy. The associations between the Forsen inventory (FI) and the risk of BC are rarely considered together in a prospective study. PATIENTS AND METHODS: In an extension of the Kuopio Breast Cancer Study, 115 women with breast symptoms were semi-structurally interviewed in-depth and asked to complete standardised questionnaires (Beck, Forsen and Spielberger) and all study variables were obtained before any diagnostic procedures were carried out. The Montgomery-Åsberg depression rating scale (MADRS) was used to evaluate the depression of the study participants. RESULTS: The clinical examination and biopsy showed BC in 34 patients, benign breast disease (BBD) in 53 patients and 28 individuals were shown to be healthy (HSS). The BC group had more severe anxiety during a two-year prodromal period (4/34 patients, 11.8%) than the BBD (3/53 patients, 5.7%) and HSS groups (1/28 patients, 3.6%). The mean sum of the scores of the FI variables during a six-year prodromal period were significantly lower in the BC group (9.8) than in the BBD (11.8) and HSS groups (12.5). In addition, the women in the BC group tended to use more psychiatric medication during a six-year prodromal period (7/34 patients, 20.6%) than the patients in the BBD (7/53, 13.2%) and HSS groups (3/28, 10.7%). CONCLUSION: The results of this study support a very weak association between the FI and BC risk. However, the number of cases with psychiatric medications was insufficient to support statistically a specific link between psychiatric medications and increased BC risk.

Beck Depression Inventory (BDI) in patients with breast disease and breast cancer: a prospective case-control study.

BACKGROUND: In 1972, Beck introduced an inventory (BDI) for rapid screening of depression. The associations between the BDI and the risk of breast cancer (BC) are rarely considered together in prospective studies. PATIENTS AND METHODS: In an extension of the Kuopio Breast Cancer Study, 115 women with breast cancer symptoms were semi-structurally interviewed in-depth as well as asked to complete standardised questionnaires (Forsen, Spielberger, MADRS), and all study variables were obtained before any diagnostic procedures were carried out. BDI was used to evaluate the depression of the study participants. RESULTS: The clinical examinations and biopsies showed BC in 34 patients, benign breast disease (BBD) in 53 patients, and 28 individuals were shown to be healthy (HSS). There was a trend for the women with HSS to have less sadness (BDI mean score, 0.27) than those of the BC (BDI mean score, 0.56) and BBD groups (BDI mean score, 0.49). The HSS group tended to be less pessimistic (BDI mean score, 0.15) than the patients in the BC group (BDI mean score, 0.44) and in the BBD group (BDI mean score, 0.42). The HSS group also had less self-accusation (BDI mean score, 0.19) than the patients in the BC group (BDI mean score, 0.50) and the patients in the BBD group (BDI mean score, 0.62). The HSS group also reported less work inhibition and weight loss than the patients in the BC group and in the BBD group. The mean sum of the scores of BDI variables was significantly lower in the HSS group (BDI mean score, 7.1) than in the BC (BDI mean score, 8.4) or BBD groups (BDI mean score, 8.8). CONCLUSION: The results of this study do not support a specific link between BDI and breast cancer risk. However, the patients with BC and BBD tended to have an increased risk for depressive symptoms.

Life stress and losses and deficit in adulthood as breast cancer risk factor: a prospective case-control study in Kuopio, Finland.

BACKGROUND: to the Authors' knowledge, the associations between the life stress and losses and deficit in adulthood and the risk of breast cancer (BC) are rarely considered together in a prospective study. PATIENTS AND METHODS: in an extension of the Kuopio Breast Cancer Study, 115 women with breast symptoms were semi-structurally interviewed in-depth, as well as asked to complete standardised questionnaires, and all study variables were obtained before any diagnostic procedures were carried out. The Montgomery-Åsberg depression rating scale (MADRS) was used to evaluate the depression of the study participants. RESULTS: the clinical examination and biopsy showed BC in 34 patients, benign breast disease (BBD) in 53 patients, and 28 individuals were shown to be healthy (HSS). The BC group had significantly higher mean score for the loss of social status in adulthood than did the BBD and HSS groups (p<0.05). In addition, the women in the BC group had significantly higher mean score for stress in adulthood in the previous 6-10 years (p<0.01), in the previous 2-6 years (p<0.05) and for stress in adulthood in the previous two years (p<0.05) than the women in the BBD and HSS groups. The BC group also had significantly more severe losses in adulthood than the BBD and HSS groups (p<0.01). The results indicated that breast cancer patients tended to have more life stress and losses in adulthood than did those in the BBD and HSS groups. CONCLUSION: the results of this study support a weak association between life stress and losses in adulthood and breast cancer risk and it might be that stress and losses impacts indirectly on breast cancer risk, affecting behaviour, or directly on the hypothalamic-pituitary-adrenal axis and autonomic nervous system functioning.

Life stress due to losses and deficit in childhood and adolescence as breast cancer risk factor: a prospective case-control study in Kuopio, Finland.

BACKGROUND: To our knowledge, the associations between the life stress due to losses and deficit at childhood and adolescence and the risk of breast cancer are rarely considered together in a prospective study. MATERIALS AND METHODS: This study is an extension of the Kuopio Breast Cancer Study. Women with breast symptoms were referred by physicians to the Kuopio University Hospital (Finland) and were asked to participate in this study. These women (n=115) were interviewed, and all study variables were obtained before any diagnostic procedures were carried out, so neither the investigator nor the participants knew the final diagnosis of breast symptoms at the time of the interview. The research method used was the semistructured in-depth interview method. The investigator used the Montgomery-Asberg depression rating scale (MADRS) to evaluate the depression of the study participants. All participants were also asked to complete standardized questionnaires (Beck depression inventory and Spielberger trait inventory). RESULTS: The clinical examination and biopsy showed breast cancer in 34 patients, benign breast disease in 53 patients, and 28 individuals were shown to be healthy. The BC group had significantly higher mean score for the deficit in childhood than the BBD and HSS groups (p<0.05). The women in the BC group had almost significantly higher mean scores for the loss of social status in childhood than the women in the BBD and HSS groups (p=0.05). The BC group had also significantly more severe deficit in childhood than the BBD and HSS groups (p=0.02). The results indicated that breast cancer patients tended to have more life stress due to losses and deficit in childhood and adolescence than BBD and HSS groups. CONCLUSION: The results of this study support a weak association between life stress due to losses and deficit in childhood and adolescence and breast cancer risk. However, the biological explanation for such an association is unclear and it might be that stress due to losses and deficit impacts indirectly on breast cancer risk, affecting behaviour, or directly on the hypothalamic-pituitary-adrenal axis and autonomic nervous system functioning.

Evaluation of women with breast disease using body image drawing analysis.

BACKGROUND: Wirsching et al. introduced a psychosocial risk scale (PRS) for psychological identification of breast cancer patients before biopsy and found that women with cancer had a tendency create bigger drawings than the women with a benign tumour. To our knowledge, the associations between body image drawing analysis and the risk of breast cancer have rarely been considered together in a prospective study. PATIENTS AND METHODS: This study is an extension of the Kuopio Breast Cancer Study. Women with breast symptoms were referred by physicians to the Kuopio University Hospital (Finland) and were asked to participate in this study. These women (n=115) were interviewed, and all study variables were obtained before any diagnostic procedures were carried out, so neither the investigator nor the participants knew the final diagnosis of breast symptoms at the time of the interview. The research method used was the semistructured in-depth interview method. The investigator used the Montgomery-Asberg depression rating scale (MADRS) to evaluate the depression of the study participants. All participants were also asked to complete standardized questionnaires (Beck depression inventory and Spielberger trait inventory). The overall content of the body image drawing was estimated using a 3-point scale: symbolistic, partly symbolistic, or humanlike. Two raters scored the body image drawings independently and the final scores were formed by comparing the separate scores of the two raters. The raters evaluated the difficulty of giving a score on a 5-point scale during scoring. RESULTS: The clinical examination and biopsy showed breast cancer (BC) in 34 patients, benign breast disease (BBD) in 53 patients, and 28 individuals were shown to be healthy (HSS). The results indicated that breast cancer patients tended to make a body image drawing of a bigger size, and to draw a less positive body image than did those in the BBD and HSS groups. The BC group also made a less differentiated and less complete body image drawing in the area of the breast than did those in the other groups. CONCLUSION: The results of this study support a weak association between the size of the body image drawing and breast cancer risk. However, the biological explanation for such an association is unclear and the exact effects of psychological factors on the various hormones relevant to the development of breast cancer are at present poorly defined.

The body image drawing analysis in women with breast disease and breast cancer: anxiety, colour and depression categories.

BACKGROUND: Wirsching et al. introduced a psychosocial risk scale (PRS) for psychological identification of breast cancer patients before biopsy and found that women with cancer had a tendency to draw bigger drawings than the women with a benign tumour. To our knowledge, the associations between the body image drawing analysis and the risk of breast cancer are rarely considered together in a prospective study. PATIENTS AND METHODS: This study is an extension of the Kuopio Breast Cancer Study. Women with breast symptoms were referred by physicians to the Kuopio University Hospital (Finland) and were asked to participate in this study. These women (n=115) were interviewed, and all study variables were obtained before any diagnostic procedures were carried out, so neither the investigator nor the participants knew the final diagnosis of breast symptoms at the time of the interview. The research method used was the semistructured in-depth interview method. The investigator used the Montgomery-Asberg depression rating scale (MADRS) to evaluate the depression of the study participants. All participants were also asked to complete standardized questionnaires (Beck depression inventory and Spielberger trait inventory). The overall content of the Body Image Drawing was estimated using a 3-point scale: symbolistic, partly symbolistic, or humanlike. Two raters scored the body image drawings independently and the final scores were formed by comparing the separate scores of the two raters. The raters evaluated the difficulty of giving a score in a 5-point scale during scoring. RESULTS: The clinical examination and biopsy showed breast cancer (BC) in 34 patients, benign breast disease (BBD) in 53 patients, and 28 individuals were shown to be healthy (HSS). The results indicated that the breast cancer patients tended to use the colours with blue and the tones of brown and black in the body image drawings than the BBD and HSS groups. The HSS group used the colours with yellow more often than did the other groups. CONCLUSION: The results of this study support a weak association between the colour category of the body image drawing and breast cancer risk. However, the biological explanation for such an association is unclear and the exact effects of psychological factors on the various hormones relevant to development of breast cancer are, at present, poorly defined.

Psychosocial risk scale (PRS) for breast cancer in patients with breast disease: a prospective case-control study in Kuopio, Finland.

BACKGROUND: In 1982, Wirsching et al. introduced a psychosocial risk scale (PRS) for psychological identification of breast cancer patients before biopsy. To our knowledge, the associations between PRS and risk of breast cancer are rarely considered together in a prospective study. PATIENTS AND METHODS: This study is an extension of the Kuopio Breast Cancer Study. Women with breast symptoms were referred by physicians to the Kuopio University Hospital (Finland) and were asked to participate in this study. These women (n=115) were interviewed, and all study variables were obtained before any diagnostic procedures were carried out, so neither the investigator nor the participants knew the final diagnosis of breast symptoms at the time of the interview. The research method used was the semistructured in-depth interview method. The investigator used the Montgomery-Asberg depression rating scale (MADRS) to evaluate the depression of the study participants. All participants were also asked to complete standardized questionnaires (Beck depression inventory and Spielberger trait inventory). The investigator estimated the PRS using a 3-point scale: grade I, low psychosocial risk; grade II, mild/moderate psychosocial risk; grade III, high psychosocial risk for breast cancer. RESULTS: The clinical examination and biopsy showed breast cancer in 34 patients, benign breast disease in 53 patients, and 28 individuals were shown to be healthy (HSS). The results indicated that breast cancer patients used more idealization of childhood, and motherhood (p=0.04) than did the other groups. PRS was significantly associated with increased breast cancer risk (p=0.05). CONCLUSION: The results of this study support a moderate association between Wirsching et al.'s PRS score and breast cancer risk. However, the biological explanation for such an association is unclear and the exact effects of psychological factors on the various hormones relevant to development of breast cancer are at present poorly defined.