Psychological distress in newly diagnosed breast cancer patients: an observational study comparing those at high risk of hereditary cancer with those of unknown risk

Abstract

Abstract Background: We compared levels of psychological distress of newly diagnosed breast cancer patients who knew they were at heightened risk of carrying a BRCA1/2 mutation (HRBC) (eg, because of young age at diagnosis and/or a positive family history) with breast cancer patients who were not assessed for their risk (unknown risk breast cancer, or URBC). Methods: We administered the Hospital Anxiety and Depression Scale (HADS) to a sample of 238 Dutch HRBC patients and 165 Norwegian URBC patients within 3 weeks of breast cancer diagnosis, prior to primary surgery. We compared HADS scores between these groups, and identified variables associated with those scores. Results: The HRBC patients reported significantly more symptoms of depression than URBC patients (P < .001, effect size = .40). The percentage of women with a suspected or probable (HADS depression score ≥8) and a probable diagnosis of depression (HADS depression score ≥11) was 29% versus 12% (P = .001) and 15% versus 5% (P = .01) in the HRBC and URBC groups, respectively. There were no significant group differences in HADS anxiety scores. In the HRBC sample, having children and psychological problems in the year before breast cancer diagnosis were associated significantly with both depression and anxiety following the diagnosis of breast cancer. Conclusions: Shortly after diagnosis, high hereditary-risk breast cancer patients report significantly higher levels of clinically relevant depressive symptoms as compared to breast cancer patients not assessed for their risk. Screening for psychological distress among high-risk breast cancer patients could facilitate timely referral to appropriate psychosocial services.