SynopsisA prospective study of 400 largely working-class women with children living at home has used measures of self-esteem and ‘social support’ to predict the risk of depression in the following year once a stressor had occurred. Actual support received at the time of any crisis in the follow-up year was also measured. Self-esteem was correlated quite highly with some of the measures of support.A core tie was defined as a husband, lover or someone named as very close at first contact. Negative evaluation of self (i.e. low self-esteem), and various indices of lack of support from a core tie at the first interview, were associated with a greatly increased risk of subsequent depression once stressor occurred. Lack of support from a core tie at the time of the crisis was particularly highly associated with an increased risk. There was also a high risk among those who were ‘let down’ - that is, for those who did not receive the support which they might have expected in terms of the first interview material. It is concluded that it is essential for prospective enquiries to take account of the actual mobilization of support in the follow-up period.

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of local recurrence is three times that of ductal carcinoma.The determination of those who selected mastectomy is interesting. In answer to the possible criticism that we may have influenced the patients to choose this treatment, we used a technique that biased the discussion towards conservation, which in the end was selected by fewer women. Bias towards conservation was also often applied by relatives and friends. Well meaning relatives may find it difficult to believe that mastectomy is genuinely the patient's choice. After a television news programme we received 20 telephone calls from relatives demanding to know why we were were not offering conservation to one of our patients, at whose choice mastectomy was due to be carried out the next morning. In the light of this we offered to postpone the operation but the patient asked us not to.We have now started a two year prospective study of the impact of choice and its possible effects on anxiety and depression. We agree with the findings of a small study from Southampton that choice does not seem to cause harm,'" but we found that only a third of patients took up the offer of conservation treatment.We conclude that women attending the breast clinic in this hospital are quite capable of playing a part in selecting their own primary treatment for operable breast cancer. Possibly patients with lobular cancers, which have a high rate of local recurrence, or in situ lesions, which are.definitely cured by mastectomy, should not be offered conservation treatment. With the advent of screening programmes this poses a dilemma:Should these patients be advised to have a mastectomy as it may offer a better chance of cure?Overall, with two thirds of women choosing mastectomy and with mnastectomy the best treatment for women with lobular lesions and cancers in situ it seems that less than 20% of women with early breast cancer will be suitable for conservation treatment. From the patients' point of view centres where conservation is available and there is enthusiasm for it should offer it as an alternative. Equally, they should make clear to the patients that a mastectomy is still an available option. Relaxation and imagery in the treatment of breast cancer Linda R Bridge, Pauline Benson, Patrick C Pietroni, Robert G Priest Abstract Objective-To see whether stress could be alleviated in patients being treated for early breast cancer.Design-Controlled randomised trial lasting six weeks.Setting-Outpatient radiotherapy department in a teaching hospital.Patients-One hundred fifty four women with breast cancer stage I or II after first session of six week course of radiotherapy, of whom 15 dropped out before end of study.Intervention-Patients saw one of two researchers once a week for six weeks. Controls were encouraged to talk about themselves; relaxation group was taught concentration on individual muscle groups; relaxation and imagery group was also taught to imagine peaceful scene of own choice to enhance relaxation. Relaxation and relaxation plus imagery groups were given tap...

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