Waiting For Biopsy Results May Be Harmful to Your Health
< Feb. 25, 2009 > -- A Harvard research study found abnormal levels of a stress hormone in women waiting for breast biopsy results.
In the US, more than a million breast biopsies are performed each year, with 80 percent of them turning up benign (non-cancerous).
In the March issue of Radiology, a research study argues for faster relaying of results, because the overall health of women waiting for breast biopsy results can be negatively affected due to abnormal levels of a stress hormone called cortisol. These levels stem from anxiety or stress and can compromise future medical treatment if biopsy results come back malignant (cancerous). This theory has been intuitively obvious to women for centuries, now scientific evidence exists due to research studies.
"For a long time, there has been the recognition that women should find out sooner what they have, but there was just not much effort put into it," says Dr. Elvira V. Lang, an associate professor of radiology at Harvard Medical School in Boston and an author of the study. "When women just say they're stressed, there's a tendency to put it aside as psychological. But once you can show there can be adverse effects on the immune system and on what the next steps are, particularly in women who may be diagnosed and women who have future interactions with the healthcare system, then this gets a completely different light on it."
"The medical community isn't going to believe this until there's some biochemical data," she adds.
"These findings don't surprise me," says Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "It's very stressful, and we try to have biopsies that have as quick a turnaround as possible. We have emergency medical records so patients today are going to get a CAT scan, are going to get off the table, walk off the elevator and see me, and get their results immediately."
Cortisol is a hormone produced by the adrenal gland and known as the "stress hormone." In challenging and/or uncomfortable situations, cortisol helps the body fight stress by adjusting and regulating blood pressure, blood sugar, and the response of the immune system. Imbalances of this hormone due to continuous stress can cause adverse effects - impairment to the immune system and wound healing.
Women, 18 to 86 years old, who were scheduled for a large-core breast biopsy were enrolled in the research study. Researchers obtained saliva samples from 126 participants. Cotton swabs were used to collect saliva samples on the day of the biopsy and four days following the scheduled procedure. The samples were tested to evaluate the cortisol levels of each participant.
Research subjects were informed of biopsy results - benign, malignant, or uncertain - within one to six days after their large-core breast biopsy. Sixteen subjects were diagnosed with breast cancer; 37 subjects were informed their biopsies were benign; and 73 subjects had biopsy results with an undetermined diagnosis that required further evaluation.
Researchers compared cortisol levels among three groups of research subjects:
- uncertain group - women who did not yet know the outcome of the biopsy,
- known malignant group - women who had a diagnosis of cancer, and
- known benign group - women who were relieved to know they did not have cancer.
The release of cortisol in the "uncertain group" was similar to the "known malignant group", but was significantly different when compared to women in the "known benign group."
"Normally, cortisol levels are high in the morning and get lower during the day, so what really counts is the slope over the daytime," Dr. Lang explains. "The cortisol mechanism is set up for responding to acute stress so we can adapt quickly, like fight or flight. That's a good thing. But if the system gets overstressed, then you don't react to quick things that happen in daily life in an appropriate fashion."
"It's not like this fine-tuned Swiss clock anymore," she adds.
If the mechanism that regulates the cortisol system is not working properly, everything from wound healing to blood sugar, blood pressure, and immune defense can be affected. "Particularly now, in these times of uncertainty, let's acknowledge that uncertainty can wreck your immune system," Dr. Lang says.
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The thought of having breast cancer is frightening to everyone, and especially devastating to women. However, ignoring the possibility that a person may develop breast cancer or avoiding the processes to detect cancer can be dangerous.
Although there are some women who are at higher risk, the fact is that all women are at risk for breast cancer. That is why it is so important to follow this three-step plan for preventive care. Although breast cancer cannot be prevented at the present time, early detection of problems provides the greatest possibility of successful treatment.
Routine care is the best way to keep you and your breasts healthy. Although detecting breast cancer at its earliest stages is the main goal of routine breast care, other benign conditions, such as fibrocystic breasts, are often discovered through routine care.
Step one is Breast Self-Examination (BSE). A woman should begin practicing breast self-examination by the age of 20 and continue the practice throughout her life - even during pregnancy and after menopause. BSE should be done regularly at the same time every month. Regular BSE teaches women to know how their breasts normally feel so that they can more readily detect any change.
Changes in the breast may include the development of a lump; a discharge other than breast milk; swelling of the breast; skin irritation or dimpling; and nipple abnormalities (i.e., pain, redness, scaliness, turning inward). If any of these changes are noticed, see a healthcare provider as soon as possible for evaluation.
Step two is a breast examination by a physician or nurse trained to evaluate breast problems. This procedure should be part of a woman's physical examination. The American Cancer Society recommends that women between the ages of 20 and 39 should have a clinical breast examination by a health professional every three years. After age 40, women should have a breast exam by a health professional every year.
A physical breast examination by a physician or nurse is very similar to the procedures used for breast self-examination. Women who routinely practice BSE will be prepared to ask questions and have their concerns addressed during this time.
Step three is mammography. Mammography is a low-dose x-ray of the breasts to find changes that may occur. It is the most common imaging technique.
Mammography can detect cancer or other problems before a lump becomes large enough to be felt, as well as assist in the diagnosis of other breast problems. However, a biopsy is required to confirm the presence of cancer.
Because of controversial questions - when to begin and how often to have mammograms - women should talk with a healthcare provider or physician about an appropriate mammography schedule based on their overall health, medical history, risk factors, and opinion or preference.
According to the National Cancer Institute, women in their 40s and older should begin having a screening mammogram on a regular basis, every one to two years. But, the American Cancer Society recommends that by age 40, women should have a screening mammogram every year. (A diagnostic mammogram may be required when a questionable area is found during a screening mammogram.)
Both organizations suggest that women who may be at increased risk for breast cancer should talk with their physicians about whether to begin having mammograms at an earlier age.
Always consult your physician for more information.