The different social contexts of mammography and BSE may explain the different rates of compliance, Dr. Lindberg suggested. Mammography is a public act recorded in medical records and also affords clinic staff the opportunity to "hold the [anxious woman’s] hand."
BSE, conversely, occurs when the woman is alone in her shower, with no one to help her manage her anxiety or support her should she find a lump, Dr. Lindberg said.
Anxiety tended to be highest at the women’s initial visit to the clinic, and symptoms dropped modestly on follow-up visits, Dr. Lindberg said. The women’s sense of vulnerability to breast cancer also declined significantly after they enrolled at the clinic, she added. But this reduction involved only the anxiety specifically related to the clinic visits and not the woman’s general level of anxiety.
Both researchers emphasized the importance of anxiety control in the management of cancer risk. "Just telling these women about cancer or screening measures does not suffice," Dr. Wellisch said. "Without help managing their anxiety, they won’t remember."
Because the women attending the high-risk clinic are self-referred, it is not clear how well they represent the entire population of women at elevated familial risk, the researchers acknowledged.
Each woman’s individual experience with breast cancer and the specifics of her family circumstances powerfully affect her psychological adjustment to elevated cancer risk, the researchers agreed. They suspect, for example, that a mother’s breast cancer has a different impact than a sister’s. Also important are whether the affected relatives died or survived, the high-risk woman’s own age at any death, and how the cancer patient reacted to her disease.
No studies, furthermore, have yet examined another important factor, the impact of the father’s reaction, especially in cases where his wife has died. But it is clear that "how fathers behave profoundly affects their daughters," Dr. Wellisch said.