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Psychological distress associated with the diagnostic phase for suspected breast cancer: systematic review


  • Mariann Montgomery,

    1. Mariann Montgomery MSN RNDoctoral StudentWest Virginia University School of Nursing, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia, USA, and Assistant Professor of Nursing Kent State University Tuscarawas, New Philadelphia, Ohio, USA
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  • Susan H. McCrone

    1. Susan H. McCrone PhD RNProfessor of Nursing and ChairDepartment of Health Promotion Risk Reduction, West Virginia University School of Nursing, Morgantown, West Virginia, USA
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M. Montgomery: e-mail:


montgomery m. & mccrone s.h. (2010) Psychological distress associated with the diagnostic phase for suspected breast cancer: systematic review. Journal of Advanced Nursing66(11), 2372–2390.


Aim.  This paper is a report of a review conducted to define the manifestations that characterize psychological distress during the diagnostic phase for suspected breast cancer, define the extent of psychological distress associated with the threat of potential cancer, and identify factors influencing psychological distress levels.

Background.  Raising the possibility that a malignancy might be present is threatening. The resulting distress is believed to influence treatment outcomes in those diagnosed with cancer and result in behavioural changes in those with benign disease.

Data sources.  Research papers published between January 1983 and May 2009 were identified in CINAHL, MEDLINE and PsycINFO. The search was performed using the following terms: breast cancer diagnosis, mammography, breast biopsy, breast diagnostic, anxiety, distress and uncertainty.

Review methods.  A systematic review was conducted of 30 studies meeting the inclusion criteria of a quantitative design with at least one standardized measure of distress and specifically addressing distress during the evaluation period.

Results.  It is well-documented that distress, manifested as anxiety, exists. In a small cohort of women, distress levels are heightened to worrying levels that may have long-term implications. There was strong evidence for relationships among medical history, education and trait anxiety with distress. There was no substantiation of the association between younger age and increased psychological distress that has been consistently reported with other cancers.

Conclusion.  It is necessary to understand the impact of factors on distress so that heightened levels can be predicted and targeted by interventions initiated at the first mention of the possibility of the presence of malignancy.