Persistent breast pain in post-surgery breast cancer survivors and women with no history of breast surgery or cancer: associations with pain catastrophizing, perceived breast cancer risk, breast cancer worry, and emotional distress

Figures & data

Figure 1. Structural equation model for breast cancer survivor group. *p<.05. Persistent breast pain total effect (including direct and indirect effects) = .23, p < .001. Note: Standardized path coefficients are displayed. Analyses included race (0 = non-white, 1 = white), age, BMI, education (0 = no college degree, 1 = college degree or more education), menopausal status (0 = pre/peri menopausal, 1 = post-menopausal), and number of body pain locations (excluding breasts) as covariates. Persistent breast pain group coded as 0 = breast cancer survivor group without persistent pain, 1 = breast cancer survivor group with persistent pain. Direct paths were included in the model from each of the control variables to the emotional distress latent variable and the observed variables for worry, pain catastrophizing, and perceived risk. Disturbance terms were allowed to correlate for the observed anxiety and depression variables, and the anxiety and mammography-distress distress variables.

Table 1. Psychological variables: Comparison of breast cancer survivor group with persistent breast pain, breast cancer survivor group without persistent breast pain, non-cancer group with persistent breast pain, and non-cancer group without persistent breast pain.

	PBP+ Survivor Group (n = 211)	PBP− Survivor Group (n = 206)	PBP+ Non-cancer Group (n = 103)	PBP− Non-cancer Group (n = 484)
	M (SD)	M (SD)	M (SD)	M (SD)
Anxiety (HADS-A )*	6.2(4.1)^a	4.7 (3.9)^b,c	5.8 (3.6)^a,b	4.3 (3.4)^c
Depression (HADS-D)*	3.1 (3.3)^a	2.3 (2.7)^b,c	2.8 (3.0)^a,b,c	2.0 (2.5)^c
Mammography-related distress*	11.0 (10.1)^a	8.2 (9.1)^b	5.8 (8.3)^c	3.7 (6.3)^c
Perceived breast cancer risk*	14.6 (6.4)^a	12.7 (6.1)^a	13.9 (5.8)^a	11.2 (5.3)^b
Breast pain catastrophizing*	6.5 (8.5)^a	4.1 (6.0)^b	7.4 (9.2)^a	3.9 (7.1)^b
	%	%	%	%
Worry breast pain indicates cancer*
No worry (0)	16.1^a	68.4^b	24.3^a	92.1^c
Mild worry (1–3)	44.5	15	44.7	5.8
Moderate to severe worry (≥4)	39.3	16.5	31.1	2.1

* p < .05. Common superscripts (a, b, c) for a variable across groups indicate no significant differences, whereas different superscripts for a variable indicate a significant difference. For comparisons a Bonferroni correction was used for each variable (i.e., α = .05/6 = .008).

Note: Unadjusted percentages and means displayed. Analyses included race (0 = non-white, 1 = white), age, BMI, education (0 = no college degree, 1 = college degree or more education), and menopausal status (0 = pre/peri menopausal, 1 = post-menopausal) as covariates. ANCOVAs were used for anxiety, depression, acute stress, perceived breast cancer risk, and pain catastrophizing. Ordinal regression was used for worry using the original 0 to 10 scale for this variable. Percentages for none, mild, and moderate to severe worry are displayed in the table.