الفهرس 
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Abstract
Breast cancer is the most common cancer in women in developed western countries and is becoming even more significant in many developing countries.
Most women with breast cancer experience at least some psychosocial distress. In all phases of the cancer trajectory, from diagnosis and treatment to long-term management, patients may experience financial strains, difficulty in interpersonal relationships, physical symptoms, and emotional distress.
This study was done among 150 patients diagnosed as breast who fulfilled the inclusion and exclusion criteria of this study whether admitted or attending the outpatient clinic of Minia oncology Center or Minia Insurance Hospital.
Diagnosis of breast cancer was confirmed with laboratory, radiological and pathological investigations. Full medical data will be obtained from hospital records regarding history, stage of the disease, type of surgical treatment and hormonal therapy. Patients will be screened for
Psychiatric comorbidity by Symptom Chick List 90 Revised.
Defense style by Defense style questionnaire (DSQ).
Personality variables by Structured Clinical Interview for DSM- IV Axis II (SCID-II).
Presence of childhood psychological trauma by Childhood Trauma Questionnaire (CTQ).
Our study objectives to assess the prevalence and associated factors of comorbid psychiatric illness in breast cancer patients, aiming to identify independent predictors of psychiatric illness among breast cancer patients.
According to our results.
We found that Three quarter (75.3%) of the patients with breast cancer were associated with psychiatric illness, while 24.7% of the study patients were not associated with psychiatric illness.
Among 113 patients who had psychiatric illness, 88 ( 58.7% ) somatization , 61 (40.7%) depression, 38 (25.3%) hostility, 37 (24.7) anxiety,35 (23.3%) obsessive compulsive, 28 (18.7%) inter personal sensitivity, 24(16%) psychotic, 20 (13.3%) phobic anxiety and lastly 11 (7.3%) paranoid ideation
Many factors may be contributing to the emergence of comorbid psychiatric illness
I) Factors related to the patients
A. Sociodemographic characteristics
In studying the relation between educational level of female patients with breast cancer we found that patients who were educated (technical and highly graduated ) were less liable to have a psychiatric illness after diagnosis of breast cancer which means that education is a protective factor for psychiatric illness.
B. Defense mechanisms and Premorbid personality
Our results revealed that, breast cancer patients with and without comorbid psychiatric illness used mature defense mechanisms more than other defenses, and most common used defense mechanism according toDSQ40 are arranged hierarchically from the most strongly used to the least used as follow; pseudo-alturism, somatization, sublimation, rationalization , reaction formation, suppression, isolation of the affect, humor, acting out, devaluation, denial, displacement, anticipation, identification, dissociation, autistic fantasy, undoing, passive aggression, splitting and finally projection was the lowest used among other defenses.
Patients with invasive duct carcinoma were significantly used isolation of the affect, splitting, somatization, rationalization, dissociation and sublimation; patients with squamous cell carcinoma were predominantly used projection, passive aggression, devaluation, denial, suppression, pseudo-altruism, anticipation and undoing; patients with metastatic carcinoma were significantly used devaluation, displacement.
from other point of view, we found that patients with cancer breast who had experienced to sexual abuse were inversely associated with the used of mature defense mechanisms while patients who had history of emotional neglect were positively associated with the use of immature defense mechanisms.
Personality characteristics are wildly related to the pattern of used defense mechanisms. In the present study we noticed that (22%) of patients had criteria of obsessive-compulsive personality, (18.7%) had borderline criteria, (16.7%) had dependent criteria, (10%) had paranoid criteria, (9.3%) had schizoid criteria and (8.7%) had criteria of histrionic personality.
The present study reported that, breast cancer patients who present with comorbid somatization (the most common psychiatric illness in our sample) were associated with less use of mature defense mechanisms and patients who used more neurotic defense mechanisms were associated with depression, phobic, sensitivity symptoms and with the intensity of the presenting symptoms. Moreover, patients with obsessive-compulsive characteristics were associated with somatization, obsessive compulsive symptoms, and phobic symptoms; patients with borderline personality characteristics were associated with anxiety and sensitivity symptoms and inversely associated with extra psychiatric symptoms like disturbance of appetite and sleep, guilt feeling and think about death; patients with dependent personality were inversely associated with impulsivity. As a result, the personality characteristics and the predominant pattern of used defense mechanisms by breast cancer patients could shape the presenting comorbid psychiatric illness.
Interestingly we found that our patients with non-operable advanced breast cancer were had criteria of avoidant and schizoid personalities. This finding may be explained by the influence of the avoidant and schizoid personality that led to delay the decision to seek medical advice for this sensitive area of the body.
C. History of childhood trauma
Out study found that two third of our participants had experienced childhood trauma-low to moderate (42.7%), moderate to severe (11.3%) and severe to extreme (12.7%)- physical neglect (70%) was the most common and sexual abuse (13.3%) was least common type of childhood trauma experienced.
Also, we found that childhood trauma experience was associated with some sociodemographic characteristics of our participants like marital, occupational and educational status.
In addition, our study reported that all domains of childhood trauma were associated with the presence of psychiatric illness in our breast cancer patients. Depression and anxiety with history of experiencing physical, emotional neglect and physical, emotional abuse; psychosis with history of experiencing of physical, emotional and sexual abuse; paranoid ideation with history of experiencing of emotional neglect and abuse; somatization with history of experiencing of emotional neglect; obsessive compulsive with history of experiencing of physical, emotional neglect and emotional abuse; impulsivity with history of experiencing of physical neglect and emotional abuse; phobia with history of experiencing of sexual abuse; extra (disturbance of appetite and sleep pattern, guilt feeling and thinking about death) with history of experiencing of physical, emotional neglect and sexual abuse and lastly sensitivity with history of experiencing of emotional neglect and sexual abuse.
Moreover, participants women with recurrent breast cancer had significant history of experiencing childhood physical neglect.
Interestingly, we noticed that women with squamous cell carcinoma were associated with history of childhood physical abuse; women with invasive duct carcinoma were associated with childhood emotional neglect.
II) Factors related to breast cancer characteristics and treatment
As regard types of current treatment, there was no significant difference between them except for patients treated by radiotherapy.
In order to study the predictor factors for comorbid psychiatric illness in patients with breast cancer logistic regression analysis was performed between psychiatric illness as dependent variable and items of structured clinical interview for DSM IV Axis II and all five domains of childhood trauma questionnaire as independent variables. We found that dependent personality and history of physical abuse were predictors for comorbid psychiatric illness in breast cancer patients.