Some women worry too much about breast cancer returning, U-M study finds

(Press-News.org) ANN ARBOR, Mich. — Most women face only a small risk of breast cancer coming back after they complete their treatment. Yet a new study from the University of Michigan Comprehensive Cancer Center finds that nearly half of Latinas who speak little English expressed a great deal of worry about recurrence.

"Some worry about cancer recurrence is understandable. But for some women, these worries can be so strong that they impact their treatment decisions, symptom reporting and screening behaviors, and overall quality of life," says study author Nancy K. Janz, Ph.D., professor of health behavior and health education at the U-M School of Public Health.

The researchers found substantial variation based on racial or ethnic background, with Latinas who speak primarily Spanish expressing the most worry and African-Americans expressing the least worry. For Latinas, the researchers considered acculturation, a measure of how much a person is integrated into American society. For Latinas, a significant factor is whether they speak primarily English or Spanish.

While 46 percent of Latinas who spoke primarily Spanish reported they worry "very much" about recurrence, that number drops to 25 percent for Latinas who speak primarily English, 14 percent for white women and 13 percent for African-Americans.

On the other hand, about 29 percent of African-American women said they were not at all worried about recurrence, while only 10 percent of Latinas who spoke little English did.

Researchers from the Cancer Surveillance and Outcomes Research Team, a multidisciplinary collaboration among five centers across the country, surveyed 1,837 women in Detroit and Los Angeles who had been diagnosed with breast cancer. Results appear in the April 1 issue of Cancer.

In addition, researchers found that women who reported understanding information better, receiving more help with their symptoms and receiving more coordinated care were less likely to worry about recurrence.

Previous studies suggested women are frequently dissatisfied with the information they receive about their recurrence risk. The current study's authors highlight the need to provide better counseling about recurrence.

"The challenge is to ensure women are aware of the signs of recurrence while not increasing anxious preoccupation with excessive worry. How much women worry about recurrence is often not aligned with their actual risk for cancer recurrence," Janz says.

"We need to better understand the factors that increase the likelihood women will worry and develop strategies to help women with excessive worry. Programs to assist women must be culturally sensitive and tailored to differences in communication style, social support and coping strategies," she adds.

### Breast cancer statistics: 209,060 Americans will be diagnosed with breast cancer this year and 40,230 will die from the disease, according to the American Cancer Society

Additional authors: Sarah T. Hawley, M.D., M.P.H.; Jennifer J. Griggs, M.D.; M.P.H.; Amy Alderman, M.D., M.P.H.; Reshma Jagsi, M.D., D.Phil.; and Steven J. Katz, M.D., M.P.H., all from U-M; Mahasin S. Mujahid, Ph.D., from the University of California Berkeley; Ann S. Hamilton, Ph.D., from the University of Southern California; and John J. Graff, Ph.D., from the Cancer Institute of New Jersey

Funding: National Cancer Institute

Disclosure: None

Reference: Cancer, Vol. 117, No. 7, April 1, 2011

Resources: U-M Cancer AnswerLine, 800-865-1125 U-M Comprehensive Cancer Center,
www.mcancer.org Cancer Surveillance and Outcomes Research Team,
www.med.umich.edu/cansort Clinical trials at U-M,
www.UMClinicalStudies.org