Abstract P5-11-10: Evaluation of the relationship between psychological distress and risk for breast cancer
Authors: Vennard K , Crocker A , Ogheneruona A , Cuke M , Wood M 
Published: March 2017

Abstract
Introduction: Women at increased risk for breast cancer (due to family history or having a pathogenic germline mutation in a cancer causing gene) have greater distress levels, which can impact quality of life and screening behavior. The goal of our study was to evaluate distress related to different risk factors for breast cancer and examine the stability of this distress over time.
Methods: Women at increased risk for breast cancer who enrolled in the High-Risk Breast Program (HRBP) at the University of Vermont Medical Center were eligible for participation. Women with strong family history, a genetic mutation or atypia on biopsy (benign breast disease, BBD) who completed the Impact of Event Scale (IES) at least once were identified. The IES is a self-reported measure designed to measure subjective distress within the past seven days in relation to a stressor. The scale is based on a two-factor intrusion-avoidance model. Linear regression was used to examine change in distress over time and to compare distress levels between risk groups. Both risk measures and distress scores were examined using bivariate plots and normal probability plots. Pearson correlation coefficients and least squares regression coefficients were obtained along with 95% confidence intervals. In addition to treating the risk estimates as continuous measures, these estimates were grouped into low or average risk (&lt;=2%) over five years, moderate risk (2%-4%) over five years, and high risk (&gt;=5%) over five years. Using the ordinal classification into three risk groups, analysis of variance was conducted to detect group differences in average psychological distress using a 5% significance level.
Results: The cohort comprised 344 women at increased risk for breast cancer due to a strong family history (80%), a genetic mutation (9%) or benign breast disease (16%). Mean IES score was 16.8 (CI 15.5, 18.2), and indicates high distress levels in this cohort. IES scores decreased over time (p&lt;0.001 and p=0.003 after 4 and 8 years, respectively). Scores did not differ between the overall group and either women with a strong family history (p=0.06) or women with BBD (p=0.8). Women with genetic mutations had higher IES scores than those without (p=0.023). IES scores were positively associated with the number of risk factors an individual had (1, 2, or 3 risk factors: p=0.003).
Conclusion: We demonstrated that distress is similar among different risk categories and that distress decreases over time; patterns not previously recognized. Women with benign breast disease have IES scores similar to women with strong family histories of breast cancer. Women with multiple risk factors are also noted to have higher scores. Women with genetic mutations appear to have the highest distress levels. These findings further our understanding of cancer related distress. Targeting women with highest distress levels may improve both quality of life and screening adherence.
Citation Format: Vennard K, Crocker A, Ogheneruona A, Cuke M, Wood M. Evaluation of the relationship between psychological distress and risk for breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-10.