Factors associated with breast cancer-specific distress in younger women participating in a family history mammography screening programme B. J. Henderson 1 *, S. Tyndel 2 , K. Brain 3 , A. Clements 2 , C. Bankhead 2 , J. Austoker 2 and E. Watson 2 on behalf of the PIMMS Study Management Group y 1 Institute of Medical and Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd LL57 2PX, UK 2 Cancer Research UK, Primary Care Education Research Group, Division of Public Health, Primary Health Care, University of Oxford, Old Road, Headington, Oxford OX3 7LF, UK 3 Institute of Medical Genetics, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK * Correspondence to: Institute of Medical and Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd LL57 2PX, UK. E-mail: b.j.henderson@ bangor.ac.uk Abstract This multi-centre study examined factors associated with breast cancer-specific distress in 2321 women under 50 who are on a mammographic screening programme on account of their family history. Women were recruited from 21 UK centres, and completed a questionnaire one month before their screening appointment. The transactional theory of stress, appraisal, and coping provided the theoretical framework for the study. Factors measured included screening history, family history, perceived risk, cognitive appraisals, coping, optimism, and cancer worry. The findings indicate that the majority of women appraise their family history as being relevant and somewhat threatening to personal well-being, but something they can deal with emotionally. Acceptance was the most commonly used coping strategy. Hierarchical regression analysis identified that the factors most significantly associated with distress were an appraisal of high relevance and threat, increased risk perception, low dispositional optimism, and the use of both avoidant and task-orientated coping strategies. Women with children and those with relatives who have died from breast cancer were also more distressed. To conclude, most women appraised their situation positively but there is a potential profile of risk factors which may help clinicians identify those women who need extra psychological support as they progress through screening. Copyright # 2007 John Wiley & Sons, Ltd. Keywords: cancer; oncology; family history of breast cancer; cancer-specific distress; stress; appraisal and coping Introduction Breast cancer is the most common cancer in the UK, accounting for over 30% of all cancers in women [1]. A family history increases the like- lihood of developing the disease [2]. The risk increases according to the number of affected relatives and the age at which they are diagnosed [3]. Specialist genetic services classify women into three risk categories of developing breast cancer based upon an assessment of their family history. Women at or near population risk have a lifetime risk of less than 17%; women at moderate risk have a 17–30% chance; and women at high risk have a lifetime risk of 30% or greater. One of the management options for women at moderate or high risk is regular surveillance. Women over 50 are able to access mammography screening through the national breast screening programme, which has been proven to be effective in reducing breast cancer mortality in this age group [4]. Women under 50 with a family history of breast cancer (FHBC) are currently recommended by the National Institute for Clinical Excellence (NICE) to have annual mammograms from age 40, or from age 35 for high-risk women if part of a research study [5]. Although there is no definitive evidence that this approach will reduce mortality in this age group, early research suggests that screening younger women with a FHBC leads to improved survival [6]. The psychological impact of mammo- graphy screening in younger women with a FHBC is unclear [7]. As part of a large prospective cohort study evaluating the psychological impact of mammography screening in women with a FHBC y Other members of the PIMMS Management Group: Stephen Duffy, Wolfson College of Preventive Medicine, London, UK; Gareth Evans, Department of Clinical Genetics, St Mary’s Hospital, Manchester, UK; Hilary Fielder, National Public Health Service of Wales, Wales, UK; Jonathon Gray, Institute of Medical Genetics, University Hospital of Wales, Wales, UK; James Mackay, Department of Biology, University College London, London, UK; Douglas Macmillan, Professorial Unit of Surgery, University of Nottingham, Nottingham, UK. Received: 25 July 2006 Revised: 15 February 2007 Accepted: 19 February 2007 Copyright # 2007 John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology (in press) Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pon.1201