PTSD Common in Women Diagnosed with Breast Cancer

Study finds incidence of post-traumatic stress symptoms in breast cancer patients to be underestimated.

Women with breast cancer were found to suffer 1 or more symptoms of post-traumatic stress disorder (PTSD) at least a year after diagnosis in a recent study.

It has been reported that women with breast cancer can develop symptoms of PTSD in the months that follow a diagnosis. However, a study published in Psycho-Oncology found that women can still show signs of PTSD even a year later.

Researchers at the Ludwig-Maximilians-Universitaet (LMU) studied 166 patients recently diagnosed with breast cancer. Participants were assessed 3 specific times throughout the following year for clinically significant symptoms of PTSD.

The data was then compared with a control group of patients without cancer.

“Cognicares is one of the very few longitudinal studies of traumatic stress associated with breast cancer," said study author Kerstin Hermelink. “Moreover, the data on which the study is based come from diagnostic interviews conducted by psychologists, and not from self-assessments. Only patients who were free of metastatic disease, and could therefore hope to get permanently cured, were recruited into the study, and women who had a history of psychiatric disease were excluded. Indeed, we assume that the study is likely to somewhat underestimate the true incidence of post-traumatic stress symptoms in breast cancer patients."

The results of the study showed that 82.5% of all patients showed signs of PTSD during the period between initial diagnosis and the initiation of treatment.

These symptoms included recurrent or intrusive reminders of experiences they associated with cancer, emotional numbness and detachment, increased arousal, sudden angry outbursts, and an exaggerated startle response.

Approximately 57.3% of participants had 1 or more continued symptoms of PTSD at 1 year, while only 2% received a full PTSD diagnosis a year after their breast cancer diagnosis.

"That the high level of stress should persist for such a long time is particularly striking," Hermelink said.

Participants in the control group were found to have a low rate of PTSD symptoms from traumatic events.

In fact, 40% of participants who had undergone a traumatic experience, such as a violent assault or a serious accident before they were diagnosed with breast cancer, found these experiences to be less severe than when they received their diagnosis.

“Neither the type of surgery nor receipt of chemotherapy had any significant effect on either of these variables, but a high level of education did have a favorable impact,” Hermelink said. “A university education is evidently a marker for resources that enable patients to recover more rapidly from the psychological stresses associated with a diagnosis of breast cancer.”

As a result of the study data, questions arose on the decision made by editors in the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders to remove “life-threatening disease” from the list of factors for potential inducers of trauma.

"In light of the results of our study, and against the background of my own experience as a psycho-oncologist with breast cancer patients, I regard this decision as highly questionable," Hermelink said. "Doctors should be made aware of the fact that the majority of breast cancer patients develop symptoms of post-traumatic stress subsequent to diagnosis, and need to receive the appropriate support."