At diagnosis, 59 breast cancer patients reported on their overall optimism about life; 1 day presurgery, 10 days postsurgery, and at 3-, 6-, and 12-month follow-ups, they reported their recent coping responses and distress levels. Optimism related inversely to distress at each point, even controlling for prior distress. Acceptance, positive reframing, and use of religion were the most common coping reactions; denial and behavioral disengagement were the least common reactions. Acceptance and the use of humor prospectively predicted lower distress; denial and disengagement predicted more distress. Path analyses suggested that several coping reactions played mediating roles in the effect of optimism on distress. Discussion centers on the role of various coping reactions in the process of adjustment, the mechanisms by which dispositional optimism versus pessimism appears to operate, third variable issues, and applied implications.

A good deal of research now indicates that the personality dimension of optimism-pessimism plays an important role in a wide range of behavioral and psychological outcomes when people confront adversity (reviewed in Scheier & Carver, 1992). What is less clear is the mechanism (or mechanisms) by which the beneficial effects of optimism take place. One possibility is that optimists do better than pessimists because they cope more effectively.' There is an abundance of evidence that they at least cope differently. Optimists and pessimists differ from one another in reports of their general coping tendencies (Carver, Scheier, & Weintraub, 1989) and in the coping responses they bring to mind when considering hypothetical situations (Scheier, Weintraub, & Carver, 1986), recalling a stressful situation from the recent past (Scheier et al., 1986), dealing with infertility problems (Litt, Tennen, Affleck, & Klock, 1992), managing a life transition (Aspinwall & Taylor, 1992), coping with a serious disease (Friedman et al., 1992), and dealing with worries about specific health threats (Stanton & Snider, 1993;Taylor et al., 1992).Far less information is available, however, concerning the hypothesis that these differences in coping serve as the vehicle by which optimists experience better eventual outcomes. Three studies in the literature are relevant to the question. One of them (Scheier et al., 1989) examined men undergoing coronary artery bypass surgery. These subjects did not complete a full measure of coping but indicated their use of several cognitive-attentional strategies before and after the surgery. Although optimism was related to several of these strategies, there was scant evidence that the strategies mediated the beneficial effect of optimism on subsequent outcomes. The second study (Aspinwall & Taylor, 1992) assessed optimism and coping in a group of students entering college and assessed well-being 3 months later. In this case, the beneficial effects of optimism appeared to operate at least in part through differences in both active coping and avoidance coping.Both of these studies have an important limitation, however. Neither included an initial measure of the variables that served as the later outcome measure. Thus,

In 1976 we began a randomized trial to evaluate breast conservation by a segmental mastectomy in the treatment of Stage I and II breast tumors less than or equal to 4 cm in size. The operation removes only sufficient tissue to ensure that margins of resected specimens are free of tumor. Women were randomly assigned to total mastectomy, segmental mastectomy alone, or segmental mastectomy followed by breast irradiation. All patients had axillary dissections, and patients with positive nodes received chemotherapy. Life-table estimates based on data from 1843 women indicated that treatment by segmental mastectomy, with or without breast irradiation, resulted in disease-free, distant-disease-free, and overall survival at five years that was no worse than that after total breast removal. In fact, disease-free survival after segmental mastectomy plus radiation was better than disease-free survival after total mastectomy (P = 0.04), and overall survival after segmental mastectomy, with or without radiation, was better than overall survival after total mastectomy (P = 0.07, and 0.06, respectively). A total of 92.3 per cent of women treated with radiation remained free of breast tumor at five years, as compared with 72.1 per cent of those receiving no radiation (P less than 0.001). Among patients with positive nodes 97.9 per cent of women treated with radiation and 63.8 per cent of those receiving no radiation remained tumor-free (P less than 0.001), although both groups received chemotherapy. We conclude that segmental mastectomy, followed by breast irradiation in all patients and adjuvant chemotherapy in women with positive nodes, is appropriate therapy for Stage I and II breast tumors less than or equal to 4 cm, provided that margins of resected specimens are free of tumor.

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Background. Recent studies indicate that breast cancer patients do not usually experience the devastating psychological consequences once viewed as inevitable. However, some adjust to the disease more poorly than others. This study examined the personality trait of optimism versus pessimism as a predictor of adjustment over the first year, postsurgery. Methods. Seventy women with early stage breast cancer reported on their general optimism‐pessimism at diagnosis. One day before surgery, and at 3‐month, 6‐month, and 12‐month follow‐ups, they reported their subjective well‐being (mood scales and a measure of satisfaction with life). At follow‐ups, they also rated their sex lives, indicated how much physical discomfort was interfering with their daily activities, and reported on thought intrusion. Results. Pessimism displayed poorer adjustment at each time point by all measures except interference from pain. Even controlling for previous well‐being, pessimism predicted poorer subsequent well‐being, suggesting that pessimism represents a vulnerability to a negative change in adjustment. In contrast, effects of pessimism on quality of sex life and thought intrusion were not incremental over time. Additional analyses indicated that effects of the optimism‐pessimism measure were captured relatively well by a single item from the scale. Conclusions. A sense of pessimism about one's life enhances a woman's risk for adverse psychological reactions to the diagnosis of, and treatment for, breast cancer. This finding suggests the potential desirability of assessing this quality informally in patients, to serve as a warning sign regarding the patient's well‐being during the period surrounding and following surgery. Cancer 1994; 73:1213–20.