Nancy K. Janz, PhD
Investigators have documented a wide variation in the extent to which women with early-stage breast cancer worry about the possibility of recurrent disease, with less acculturated Latina women most likely to worry excessively. The findings are based on responses to questionnaires completed by a large multiethnic, population-based sample of women with nonmetastatic breast cancer at a mean of 9 months after their diagnosis.
The study revealed that 46% of Latina women who spoke primarily Spanish were most likely to report high levels of worry compared with only 25% of Latinas who mostly spoke English (P <.001). Only 14% of white women and 13% of black women said that they worry “very much” about recurrence.
“How much women worry about recurrence is often not aligned with their actual risk for cancer recurrence,” said Nancy K. Janz, PhD, with the University of Michigan School of Public Health in Ann Arbor, and colleagues in a news release. Accordingly, she called for studies that better delineate why some women worry excessively about breast cancer recurrence. Vulnerable women could eventually be targeted for interventions to help reduce their risk.
The final analysis included 1837 white, black, and Hispanic women in Los Angeles and Detroit who had been diagnosed with primary ductal carcinoma in situ or invasive breast cancer stages I, II, or III between June 2005 and February 2007, and reported to the National Cancer Institute’s local Surveillance, Epidemiology, and End Results (SEER) registries. Asian women were excluded because they were enrolled in other studies.
"These interventions must be culturally sensitive and tailored to differences in communications style, social support, and coping strategies."
–Nancy K. Janz, PhD
Because of advances in the diagnosis and treatment of breast cancer, most women with early-stage disease have a favorable prognosis, Janz and associates noted. A heightened focus on worry and its correlates is essential, given that survivors have consistently cited worry about recurrence as one of their most “pressing” concerns, coupled with studies that have shown that excessive worry can interfere with treatment decision making and surveillance behaviors and also cause depression, anxiety, and decreased quality of life. In particular, little is known about whether worry differs across racial/ ethnic groups.
In the study, women responded to a 3-item worry scale in which they were asked to indicate how worried they were about a cancer recurrence in the same breast, a cancer occurrence in the other breast, or the development of metastatic disease. The researchers also determined the level of acculturation in the Hispanic women by asking them to indicate their preference for English or Spanish in different contexts, such as reading or speaking at home or with friends. Women were considered less acculturated if they indicated a strong preference for Spanish.
The analysis showed that race, ethnicity, and acculturation were associated with differences in worry about recurrence. Women who had greater ease in understanding clinical information, women who had fewer symptoms, and women who received more coordinated care reported being less worried about recurrence.
46% of Latina women who spoke primarily Spanish were most likely to report high levels of worry compared with only 25% of Latinas who mostly spoke English.
“For women with excessive worry, appropriate referrals could be targeted at their unique concerns,” said Janz and associates. “These interventions must be culturally sensitive and tailored to differences in communications style, social support, and coping strategies.”
They added that the results are bolstered by the inclusion of a large population-based sample with sufficient numbers of Latinas to allow for an examination of the relevance of acculturation. On the other hand, because of the study’s crosssectional design, it was not possible to examine worry over time.
Janz NK, Hawley ST, Mujahid MS, et al. Correlates of worry about recurrence in a multiethnic population-based sample of women with breast cancer [published online ahead of print March 28, 2011]. Cancer. doi: 10.1002/cncr.25740.