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Coping and defending as risk factors for breast cancer in patients with breast disease; a prospective case-control study in Kuopio, Finland.

BACKGROUND
The purpose of this study was to assess the role of coping and defending mechanisms as a risk factor for breast cancer. Women with breast symptoms were referred by physicians to the Kuopio University Hospital (Finland) and were asked to participate in this study.


PATIENTS AND METHODS
The women (n=115) were interviewed and all study variables were obtained before any diagnostic procedures were done, so neither the investigator nor the subject knew the final diagnosis of breast symptoms at the time of the interview. The research method used was the semistructured in-depth interview method. The investigator used the Montgomery-Asberg Depression rating scale (MADRS) to evaluate the depression of the study subjects. All study subjects were also asked to complete standardised questionnaires (Beck Depression Inventory and Spielberger Trait Inventory). The investigator used the modified coping and defence inventory made by Haan. This inventory is divided into ten scales, and each scale has subscales from grade 0 to grade 3. In addition, the researcher estimated the patients ability to cope (scale 1 to 5), the amount of defensiveness (scale 1 to 5) and fragmentation (scale 1 to 5).


RESULTS
Clinical examination and biopsy showed breast cancer (BC) in 34 patients, benign breast disease (BBD) in 53 patients, while 28 study subjects were healthy (HSS). The results indicated that breast cancer patients used more defending mechanisms; denial, intellectualising, rationalisation and reaction formation than the BBD and HSS groups. The defensive mechanisms were significantly associated with increased breast cancer risk (RR=1.7, CI=1.1-2.6). In addition, the breast cancer patients used less coping mechanisms; concentration, intellectuality, logical analysis, empathy, ambiguity tolerance, regression-ego, sublimation and substitution.


CONCLUSION
The results of this study support a moderate association between unsatisfactory coping and defending mechanisms and increased breast cancer risk. The biological explanation of the association might be that coping and defending processes impact directly on the hormonal, immune and nervous systems, or indirectly by affecting behaviour such as diet, exercise or sleep.