Psychological Stress Versus Outcome in Patients With Breast Disease and Breast Cancer: A Prospective 25-year Follow-up Study in Patients With Breast Cancer Symptoms

Background/Aim: This study evaluated whether a psychological inventory (Forsen inventory, FI) for measuring the severity of psychological stress (PS) could predict long-term outcomes in patients having breast carcinoma (BC) symptoms. Patients and Methods: A total of 115 patients with BC symptoms completed the FI scale and associations between FI scale and long-term outcomes were analysed using survival models. Results: The FI scores correlated with Beck Depression Inventory (BDI) (r=0.678, p<0.001), Montgomery-Asberg Depression Rating Scale (MADRS) (r=0.820, p<0.001), and State-Trait Anxiety inventory (STAI) (r=0.556, p<0.001) levels. In Cox regression models, higher FI scores predicted poorer 25-year relapse-free survival (RFS) in BC patients (HR=2.60, p=0.05) and poorer 25-year overall survival (OS) in patients with benign breast disease (BBD) (HR=7.79, p=0.05). Kaplan-Meier analysis showed significantly better 25-year RFS among BC patients with low FI scores (<14) compared to those with high scores (≥14) (58.3% vs. 30.0%, p=0.046), and higher 25-year OS in BBD patients with low FI scores (95.8% vs. 71.4%, p=0.022). Conclusion: The FI scale, though underutilized, effectively captures PS and significantly predicts long-term outcomes in patients with breast disease. These findings suggest that incorporating the FI into diagnostic evaluations could enhance risk stratification and management for women with BC symptoms.