Evaluation of women with breast disease using body image drawing analysis

Wirsching et al. introduced a psychosocial risk scale (PRS) for psychological identification of breast cancer patients before biopsy and found that women with cancer had a tendency create bigger drawings than the women with a benign tumour. To our knowledge, the associations between body image drawing analysis and the risk of breast cancer have rarely been considered together in a prospective study.

This study is an extension of the Kuopio Breast Cancer Study. Women with breast symptoms were referred by physicians to the Kuopio University Hospital (Finland) and were asked to participate in this study. These women (n=115) were interviewed, and all study variables were obtained before any diagnostic procedures were carried out, so neither the investigator nor the participants 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 participants. All participants were also asked to complete standardized questionnaires (Beck depression inventory and Spielberger trait inventory). The overall content of the body image drawing was estimated using a 3-point scale: symbolistic, partly symbolistic, or humanlike. Two raters scored the body image drawings independently and the final scores were formed by comparing the separate scores of the two raters. The raters evaluated the difficulty of giving a score on a 5-point scale during scoring.

The clinical examination and biopsy showed breast cancer (BC) in 34 patients, benign breast disease (BBD) in 53 patients, and 28 individuals were shown to be healthy (HSS). The results indicated that breast cancer patients tended to make a body image drawing of a bigger size, and to draw a less positive body image than did those in the BBD and HSS groups. The BC group also made a less differentiated and less complete body image drawing in the area of the breast than did those in the other groups.

The results of this study support a weak association between the size of the body image drawing and breast cancer risk. However, the biological explanation for such an association is unclear and the exact effects of psychological factors on the various hormones relevant to the development of breast cancer are at present poorly defined.