The effects of major depression and phobia on stage at diagnosis of breastcancer

Objective: To examine the longitudinal effects of major depression and phob ia on stage at diagnosis of subsequent breast cancer. Method: Data from the New Haven Epidemiologic Catchment Area (ECA) study were linked to the Conn ecticut Tumor Registry (CTR). The sample comprised of seventy-two women wit h a first primary breast cancer diagnosed sometime after their baseline ECA study interview. In the ECA study, lifetime psychiatric history was assess ed using the Diagnostic Interview Schedule based on DSM-III criteria. Stage at diagnosis of breast cancer was taken from CTR records and dichotomized into early stage (in situ and localized tumors) versus late stage (regional and distant tumors). Results: A positive history of major depression was a ssociated with an increased likelihood of late-stage diagnosis of breast ca ncer (odds ratio [OR] = 9.81, p = 0.039), whereas a positive history of pho bic disorders was associated with a decreased likelihood of late-stage diag nosis (OR = 0.01, p = 0.021), controlling for sociodemographic characterist ics of the sample. Conclusions: These analyses revealed a longitudinal asso ciation between reported lifetime psychiatric history and stage at diagnosi s of subsequent breast cancer. Phobia may motivate women to adhere to breas t cancer screening recommendations and to report suspicious symptoms to a p hysician without delay. Major depression, on the other hand, was identified as an important predictor of late-stage diagnosis; proper recognition and management of depression in the primary care setting may have important imp lications for breast cancer detection and survival.