UCI WOMEN'S BIOBEHAVIORAL PROCESSES AND HEALTH STUDY

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Breast cancer (BC) is presently a major health issue for women in the United States (American Cancer Society, 1995; Feuer et al 1993). Established risk factors for BC (e.g., age, gene mutations, familial and reproductive history) account for only a limited proportion of variance in disease incidence and progression (Fox et al, 1994); moreover, most of these risk factors are immutable at the present time. The search for additional risk factors has prompted clinicians and behavioral scientists to address a long-standing and critical question: what is the relationship between psychosocial processes and breast cancer? This effort has generated a literature of seemingly contradictory findings. However, two major classes of prognostic variables of probable significance for BC incidence as well as progression have been identified -- stress and psychological coping style. The major weakness of this body of psychosocial oncology research are: (1) the dependence on self-report measures (questionnaires) to assess psychological distress and coping style (Schwartz, 1995) and (2) a poor understanding of the biological substrates of these psychological factors. The broad objective of the present program of research is to study putative biological processes that may mediate the links between psychological states and cancer. Specifically, the present study is designed to conduct a cross-sectional investigation to examine associations between biological indices of stress reactivity and psychological coping styles in women with early stage breast cancer (n=75) and healthy, matched controls (n=75) recruited from a University-based comprehensive breast cancer care center (UCI Chao Family Comprehensive Cancer Center). A central feature of this study is the proposed use of a laboratory-based behavioral challenge paradigm. The behavioral challenge is a standard operationalization of psychological challenge that evokes responses from the same physiologic systems that are involved when an individual experiences psychosocial stress. The responses of subjects undergoing this mild challenge are thus representative of their responses to psychosocial stress, yet the challenge, given in a controlled setting, is brief and the psychological and biological responses evoked in subjects is minimal. The behavioral challenge procedure involves exposure to a mild, standardized behavioral challenge and multiple, longitudinal measurements of biological parameters before, during, and after the challenge application. The significance of this methodology in the present context is that it addresses the weaknesses in the literature described above by facilitating (1) more direct assessment of an individual's stress response and coping study that is relatively unbiased by appraisal and self-report and (2) the assessment of reactivity of biological systems (e.g., autonomic nervous, neuroendocrine systems) that are related to the challenge and may be related directly or indirectly to breast cancer risk/progression. In the present study, biological reactivity to challenge will be measured by quantifying changes in heart rate, blood pressure, and plasma levels of ACTH and cortisol in response to the behavioral challenge, whereas psychological coping styles will be measured by quantifying discrepancies between biological and self-report indices of arousal in response to challenge protocol. The major study hypothesis to be tested is that women with breast cancer will exhibit significantly greater biological stress reactivity than healthy controls. Secondary hypotheses are that women with a positive family history of BC will exhibit greater biological stress reactivity than women with a negative family history, and postmenopausal women will exhibit greater stress reactivity than premenopausal women. The specific aims of thie study are: Specific Aim 1: To quantify parameters of biological reactivity to a behavioral challenge paradigm in women with and without breast cancer. Specific Aim 2: To examine (a) group differences between women with and without breast cancer in biological stress reactivity, and (b) the effects of menopause and familial risk on biological stress reactivity and emotional expression. Specific Aim 3: To develop the methodology and obtain preliminary data which could justify subsequent, prospective research with high-risk populations.