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The efficacy of prophylactic surgery and potential surgical complications are discussed. Data about the frequency of use and psychosocial impact of prophylactic surgery in young women is also presented along with general treatment guidelines for the practicing clinician.

The article discusses that integrative cancer care, simply substitute integrative oncology, complementary cancer care, integrative whole person cancer care, and alternative medicine. It mentions the National Cancer Institute is the only Institute among the 27 at the National Institutes of Health that has such an office distinct from the NIH National Center for Complementary and Integrative Health (NCCIH); and also mentions several integrative oncology interventions do not fit the definition.

Risk-reduction mastectomy (RRM), also known as bilateral prophylactic mastectomy, is a controversial clinical option for women who are at increased risk of breast cancer. High-risk women, including women with a strong family history of breast cancer and BRCA1/2 mutation carriers, have several clinical options: risk-reduction surgery (bilateral mastectomy and bilateral oophorectomy), surveillance (mammography, clinical breast examination, and breast self-examination), and chemoprevention (tamoxifen). We review research in a number of areas central to our understanding of RRM, including recent data on 1) the effectiveness of RRM in reducing breast cancer risk, 2) the perception of RRM among women at increased risk and health-care providers, 3) the decision-making process for follow-up care of women at high risk, and 4) satisfaction and psychological status after surgery. We suggest areas of future research to better guide high-risk women and their health-care providers in the decision-making process.

The purposes of this study were to assess the long-term effect of adverse childhood experiences (ACEs) on blood pressure (BP) trajectories from childhood to young adulthood and to examine whether this relation is explained by childhood socioeconomic status (SES) or risk behaviors that are associated with ACEs.

Abstract Despite numerous individual studies of psychological factors (depression, anxiety, distress) related to genetic testing for inherited cancer syndromes (CGT), there has been no systematic review of the psychological factors are measured among individuals at increased risk for hereditary breast, ovarian, or colon cancer. Our review provides an analysis of psychological factors in studies of CGT and discusses the instruments most commonly used to measure them. We performed a literature search using three major OVID databases from 1993 to January 2003. In the 19 studies that met our inclusion criteria, the most commonly assessed psychological factors were distress, anxiety, and depression. These factors were most often measured by the impact of event scale (IES), the state-trait anxiety inventory (STAI), and the Centers for Epidemiologic Studies and Depression scale (CES-D), respectively. Our results show deficits in the existing body of literature on psychological factors associated with CGT including limited documentation of psychometrics and variability in instrumentation.

Background.Little is known about the perception of bilateral prophylactic mastectomy (BPM), and whether perceptions are influenced by a family history of breast cancer. It is also unclear what factors may play a role in selecting BPM for follow-up care.

The present study examined the use of inhibiting and facilitating self-statements (i.e., self-statements that make it harder or easier to deliver an effective social response) in groups of withdrawn (n = 33), aggressive (n = 32), and popular (n = 27) children. These self-statements were studied across two types of interpersonal situations (resolving conflict, initiating social interactions) and two levels of interpersonal relationship (friend, stranger). Results indicated that popular children made significantly more facilitating than inhibiting responses than aggressive or withdrawn children, who did not differ from one another. In addition, results indicated a tendency for children in all three status levels to endorse more facilitating than inhibiting self-statements in situations involving friends (vs. strangers) and the initiating of social behavior (vs. conflict situations). Finally, a Relationship ×Situation interaction was found, indicating significantly more facilitating self-statements than inhibiting self-statements for all three groups in situations involving initiating interactions with friends.

The present study assessed the prevalence, severity, and other parameters of illness-related worry among 83 cancer patients receiving active treatment for their illness. Participants completed questionnaires assessing a variety of worry dimensions. In addition, a family member of each patient completed a brief questionnaire regarding their perception of the patient's illness-related worry. Nurse ratings of patients' clinic-related behaviors were obtained. Fifty-one percent (n = 43) of patients reported worry to be at least "somewhat of a problem. " Fifteen percent (n = 12) reported it to be a significant to severe problem. Significant correlations included patients self-rating of worry and: nurse rating of clinic behavior, total score on a Worry Content Scale, ability to stop worrying once started, and impact of worry on mood and functioning. Rating by the significant other of how much of a problem worry-was for the patient and whether the patient was a worrier preillness was also significantly correlated. There were no significant differences between "worriers " and "nonworriers" on demographic or disease variables. A logistic regression model using the categories of "worriers" or "nonworriers" as a dependent variable found that women and patients reporting poor social support were more likely to report a problem with worry. However, a large amount of the variance remained unexplained.

Previous studies have found high levels of psychological distress in women who have a family history of breast cancer. We evaluated a brief Problem-Solving Training (PST) intervention designed to reduce distress among women with a first-degree relative recently diagnosed with this disease. Participants were randomly assigned to either the PST group (N=144) or a General Health Counseling (GHC) control group (N=197). At baseline, these groups did not differ on any sociodemographic, risk factor, or psychological distress variables. We evaluated the impact of PST, relative to GHC, at the three-month follow-up assessment using a 2 (treatment group)×2 (time of assessment) mixed factor analysis of variance (ANOVA). Although there were significant decreases in both cancer-specific and general distress in both the PST and GHC groups, the magnitude of these decreases did not differ. However, when PST participants were divided into those who regularly practiced the PST techniques and those who did not, significant differences emerged. Participants who regularly practiced the PST techniques had significantly greater decreases in cancer-specific distress [Impact of Event Scale (IEs) intrusion and avoidance subscales] compared to infrequent practicers and GHC participants. Effects on general distress were not found. Additional studies are needed to identify ways to promote the practice of PST techniques and to evaluate other psychosocial interventions for female relatives of breast cancer patients.

First-degree relatives (FDRs) of women with breast cancer may have heightened anxiety about their personal risk for developing breast cancer. Breast self-examination (BSE) is an important component of risk surveillance for all women. In this study, the authors describe a subset of FDRs who appear to excessively (≥ once per day) perform BSE. These women, who constituted 8% of 1,053 FDRs in this study, were compared with women who did not examine excessively. The excessive self-examiners were older, more frequently African American, and less educated. They were more likely to have an affected daughter and ≥ two FDRs with breast cancer. They were significantly more likely to think frequently about breast cancer and to report that such thoughts affected their mood. In a multivariate analysis, three variables had significant independent associations with excessive BSE practice: ethnicity (odds ratio [OR] = 2.3), perceived risk of breast cancer compared with women without a family history (OR = 2.9), and frequency of thoughts about breast cancer (OR = 5.5). The women who practice excessive BSE would benefit from enhanced educational efforts and screening for the presence of psychiatric problems such as anxiety and hypochondriasis.

Two sessions of relaxation instructions were administered under high and low expectancy conditions. Fifty-four college students scoring high on a self-report measure of anxiety served as subjects. Live and taped abbreviated progressive muscle relaxation instructions and a self-relaxation condition were equally effective in reducing within-session self-report and physiological indices of anxiety. High expectancy instructions led to greater reductions in heart rate than did low expectancy instructions. Factors controlling anxiety reduction during relaxation therapies are discussed.

As an initial part of a project to develop a model informed consent process for BRCA1 testing, we conducted a series of focus groups. At the groups, women initially expressed great interest in testing, but their interest diminished after learning more. If offered testing, women would most want to learn about test accuracy, practical details of testing, and management options if the result was positive. Perceived benefits of testing included gaining information leading to risk reduction, relief of uncertainty, more responsible parenting, and assisting in research. Perceived risks included the discomfort and cost of the testing process itself, and anxiety after a positive result. The risk of possible insurance discrimination was rarely mentioned spontaneously. Many women would want their providers to make recommendations, rather than be nondirective about testing. We observed that women vary greatly in their informational and counseling needs, and suggest that the informed consent process should be individualized, taking into account a woman's perception and her preferences for how testing decisions should be made.

The psychological status of 126 oncology outpatients with heterogeneous diagnoses and few ensuing physical limitations was assessed with the Brief Symptom Inventory during initial registration at the clinic. Approximately one in three patients reported moderate to high levels of depression and anxiety. The level of distress was not significantly influenced by sex, marital status, or activity status. Based on these results, roughly one fifth of oncology outpatients may warrant ongoing evaluation or intervention for psychological distress.