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A consecutive series of 160 women admitted to hospital for breast tumor biopsy was assessed prior to, and at 3, 12, and 24 months following operation for marital, sexual, interpersonal and work adjustment, depression, and personality characteristics by means of rating scales based on structures interviews and standard tests. By 2 years there wery no significant differences in social adjustment between mastectomy patients and benign breast disease controls; 70% of cancer patients were no longer stressed by mastectomy at 1 year. Factors predicting poor adjustment to mastectomy were high preoperative scores on the Hamilton Rating Scale for Depression and the Neuroticism Scale of the Eysenck Personality Inventory; deterioration in sexual adjustment was associated with biological or chronological perimenopausal status. Significantly more cancer than benign disease patients were dissatisfied with the information they received about operation and diagnosis. Implications of these findings for the care of the mastectomy patient are discussed.

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The relationship between psychological response (PRD) to cancer diagnosis measured three months post-diagnosis and disease outcome up to five years later was studied prospectively in a consecutive series of 107 women with early (To-2, No-1 , Mo) breast cancer and a consecutive series of 61 men and women with Hodgkin's and Non-Hodgkin's lymphoma. It was only possible to assign 138 patients (88 breast cancer and 50 lymphoma) to single psychological response categories. In those who could be so categorised a significant trend of worsening prognosis as response varied from 'fighting spirit' or 'denial' through 'anxious preoccupation' to 'stoic acceptance' or 'hopelessness/helplessness', was demonstrated for both overall survival (xZ = 5.49; p = 0.02) and recurrence-free survival (x' = 6.09; p = 0.015). Male lymphoma patients who had died by five years tended to have higher scores on the suppression of anger scales of the Courtauld Emotional Control Scale and the 'Powerful Others Scale' of the Mental Health Locus of Control Scale; they more often reported avoiding seeking information or 'keeping busy' as a way of avoiding thinking about their diagnosis structured interview data in the study are discussed.The relative values of psychological test scores and serni-