Clinically assessed posttraumatic stress in patients with breast cancer during the first year after diagnosis in the prospective, longitudinal, controlled COGNICARES study Varinka Voigt 1 , Franziska Neufeld 1 , Judith Kaste 1 , Markus Bühner 2 , Philipp Sckopke 2 , Rachel Wuerstlein 1 , Karin Hellerhoff 3 , Anikó Sztrókay-Gaul 3 , Michael Braun 4 , Franz Edler von Koch 5 , Eliane Silva-Zürcher 1 , Stephan Hasmüller 1,6 , Ingo Bauerfeind 7 , Gerlinde Debus 8 , Peter Herschbach 9 , Sven Mahner 1 , Nadia Harbeck 1 and Kerstin Hermelink 1 * 1 Breast Center, Department of Gynecology and Obstetrics, CCC LMU University Hospital of Munich, Munich, Germany 2 Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany 3 Institute for Clinical Radiology, CCC LMU University Hospital of Munich, Munich, Germany 4 Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany 5 Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany 6 Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany 7 Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany 8 Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany 9 Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany *Correspondence to: Kerstin Hermelink, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Marchioninistr. 15, D-81377 Munich, Germany. E-mail: kerstin.hermelink@med.uni- muenchen.de Received: 25 September 2015 Revised: 21 January 2016 Accepted: 22 January 2016 Abstract Objective: There is ongoing debate whether cancer qualifies as traumatic stressor. We investigated prevalence and course of posttraumatic stress in patients with early breast cancer (BC) during their first year after diagnosis and determined effects of mastectomy and chemotherapy. Methods: Patients with stage 0–III BC aged ≤65 years were evaluated with the Structured Clinical Interview for DSM-IV modules for acute and posttraumatic stress disorder (ASD and PTSD, respec- tively) before treatment, after chemotherapy, and 1 year after diagnosis. Matched controls were assessed at matched intervals. Effects of time, mastectomy, and chemotherapy on BC-related PTSD symptom severity were tested with linear mixed model analysis. Results: Stress disorder (ASD or PTSD) related to BC was diagnosed in 6 (3.6%) of 166 patients be- fore treatment and in 3 patients (2.0%) 1 year later. The rate of patients who experienced PTSD symp- toms related to BC decreased from 82.5 to 57.3% (p < 0.001), and the mean of BC-related PTSD symptoms diminished from 3.1 to 1.7 (p < 0.001). Only university education significantly predicted the course of BC-related PTSD symptom severity (p = 0.009). In 60 controls, no diagnosis of stress dis- order, a rate of 18% women experiencing PTSD symptoms, and a mean of 0.4 PTSD symptoms (p vs. patients <0.001) were found. Conclusions: Most newly diagnosed patients with BC experience PTSD symptoms, whereas full di- agnoses of DSM-IV stress disorder are rare. Symptoms diminish somewhat within 1 year furthered by university education but independently from mastectomy and chemotherapy. Throughout the year af- ter diagnosis, having BC entails markedly increased PTSD symptom burden. Copyright © 2016 John Wiley & Sons, Ltd. Background Posttraumatic stress disorder (PTSD) occurs after expo- sure to extremely stressful events and is characterized by symptoms of intrusion (e.g. involuntary recurrent memo- ries, dreams, or flashbacks of the stressor), avoidance (e.g. efforts to avoid memories, thoughts, feelings, or reminders associated with the stressor), emotional numb- ing, and hyperarousal [1]. In the general population, 12- month prevalence of PTSD is reported to be about 3.5% in the USA and to cluster around 0.5–1.0% in Europe [2]. Since life-threatening illness was included as poten- tially traumatic event in DSM-IV [1], a growing body of research has investigated cancer-related PTSD predomi- nantly in breast cancer (BC) populations. In studies that used clinical interviews based on DSM- IV criteria [3–8], rates of PTSD related to BC varied be- tween 2.4 [6] and 6% [8]. Higher rates were found when PTSD was assessed with self-report questionnaires [9,10]. These instruments, however, do not involve Copyright © 2016 John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology 1–7 (2016) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.4102