Tuesday, March 3, 2009

Waiting and Stress and Breast Biopsies

This article from Radiology highlights a common source of stress that many women face; the stomach-churning, mind-wracking interval while you wait for the final pathology to be determined from your breast biopsy. The cited article measured salivary cortisol levels in women throughout the waiting period after core needle breast biopsies. What they found was that stress hormone levels were just as high during the waiting period as levels determined in women who were told the biopsy was positive for cancer.

The science of the paper isn't great and the conclusions made regarding wound healing with mildly elevated cortisol levels is conjectural at best, but papers like this don't have to be great science. The point is that women experience a tremendous amount of emotional stress while waiting for breast biopsy results and we as physicians ought to do everything we can to get those results to them as soon as possible. For core or needle biospies, it ought not to take more than 24-48 hours. For lumpectomies or axillary dissections however, it could very well take several days but no woman should be waiting more than a week.

For obvious reasons I cannot imagine what it's like to go home with a bandaid on a wound after a breast biopsy to determine whether "something" seen on your mammogram is or is not a cancer and being forced to go through the subsequent days, taking care of your family and going to work and just trying to live your life, all the while in the back of your mind you're wondering, wondering. The stress often starts days prior to even seeing a surgeon. A woman will get a call randomly from her PCP or her Gyne about a "finding" on her last mammogram and that she needs to see a Surgeon (a surgeon?!??!) as soon as possible, here's the number. Then maybe the surgeon can't get you in until later in the week. Finally you meet him and he tells you that since the "lesion" (now it's a lesion????) can't be palpated, you'll have to go for a stereotactic core needle biopsy, to be set up in the department of radiology with a different doctor in a few days. And then the day of the biopsy arrives and it isn't so bad, the discomfort, but you go home again without answers. And you wait. And every time the phone rings your heart quivers and jumps just a bit knowing it could be your surgeon's voice; we need to talk, could you come into the office this afternoon.....

The whole process can sometimes get dragged out over several weeks. For me, it's good to be reminded every now and then that there is an actual person who has to endure the torment of the wait.....


HMS said...
This comment has been removed by the author.
HMS said...

Patients most often appreciate such gesture of understanding and support (in person or not) especially during time of unavoidable uncertainty.

Rita - Supporting Safer Healthcare said...

Been there, done that, more than once. The wait is absolutely nerve-wracking.

The last time I was told the mammogram looked highly suspicious. After waiting to have the core biopsy, I waited another entire week for the results. When the physician finally called and said negative, I responded that I was relieved because I'd been so sure they were going to be positive again. She said "Really?" in a way that made me feel a bit like a hypocondriac. Hmm, not a pleasant experience over all.

Not really enthusiastic about that "annual" mammogram any more, although eventually I'll get around to another one.

rlbates said...

"For me, it's good to be reminded every now and then that there is an actual person who has to endure the torment of the wait....."

I agree with you Buckeye.

OHN said...

Realizing that there is a person at the other end waiting for that report is one of the things they don't teach in medical school, but is one of the markers of a very good physician.

Anonymous said...

The stereotactic core needle is awful!
They strap you face down onto a table with the breast to be biopsied hanging out a hole in the table. They they clamp and maneuver a 'gun' around to take the samples using an image on an associated screen.

Do you like to lie on your stomach head turned to the side for an hour? Then they do another mammogram to verify the tag that they leave in.

Don't talk about how it's not so bad until you've been there!

Chrysalis said...

I am so glad to see there are many doctors out there that get this. Happy Hospitalist had a post similar to this a short time ago. Waiting is agony.

One time I had a doctor say to me, concerning a procedure, that it was "routine" in these cases. I looked at him, and I said nicely, "It isn't routine for me." He and his nurse just froze for a moment. It's day to day for those in medicine, but it isn't for the patient.

Anonymous said...

thank-you most genuinely to all of those in health care who pro-actively CHOOSE to make the effort to reflect upon what their patients may be experiencing. If there were more of you, medicine and health care would experience a revolution.

teddy123 said...

I am sooo SCARED...I have a core biopsy tomorrow and have been worried since I had a recall mammo...one month later and now I am suffering from DEPRESSION!! PLease HELP ME!

Chrysalis said...

Teddy, I saw your comment. I have been there.

It is frightening to worry and not know, but right now the most important thing to do is stay focused. It's normal to be scared; I was scared too. You must keep your head about you, and listen to what your doctors are saying to you during this. I hope you have someone to go with you to the appointments, it helps to have another pair of ears during this time. There can be so much to take in. If you'd like you can email me. I'm at chrysalisangel@gmail.com

Anonymous said...

It's been THIRTY days since a routine breast MRI (my first time due to family history/high risk) found "something suspicious". It took two whole weeks until the day of the ultrasound guided biopsy. The ultrasound could not show the lesion from the MRI so I had to wait TWO more WEEKS for an MRI guided biopsy. It's been two days since then. The biopsy itself was not painful, but very nerve wracking. It was done with a needle while I was in MRI, they took about 12 samples. That was 2 days ago. Lots of bruising on breast and it was bleeding for about 1.5 days, now it's healing. Now I am waiting by the phone, in bed, collapsed from mental stress, unable to function. Waiting is killing me. I have held it together most of the past month especially so my young kids wouldn't see mommy cry but today they are at school and I've fallen apart. Waiting for the phone to ring, heart palpiltating. It's true -- waiting is as bad as bad news. I am praying for good news. I am in a major city in Canada -- perhaps that's why this process has taken so long. Good care but have to wait for appointments, availability of MRI machine, etc.

Anonymous said...

As a follow up to my comment below about waiting 30 days, I got the results of my biopsy and it was good! Thank goodness my husband is a pathologist and knows all the pathologists in the city and had my biopsy sent to a specific one who looked at it as soon as she got it (48 after my biopsy) and she called him with the results immediately so we knew. Otherwise I'd have had to wait 3 more days until the requisitioning doctor's office called to inform me. The stress was horrible. Waiting and worrying. And my family doctor's office called me 11 days after the biopsy to say all is well, no cancer. Imagine if I'd waited 11 days with no news! I emailed my doctor with some constructive feedback about stress and waiting. Well it's been almost a month now since biopsy, the bruising is almost gone but I still have a lump that they told me the biopsy would cause. That should eventually go away. And still have a small dark mark where the needle went in, not quite healed yet. I am so grateful it was benign. Good luck to everyone going through similar situations.

Juanita Blog said...

Anonymous posted about
.... "The stereotactic core needle is awful!
They strap you face down onto a table with the breast to be biopsied hanging out a hole in the table.

< clipped>

Don't talk about how it's not so bad until you've been there!
I just had this done today. There are pillows and cushions, you just make yourself comfortable. It took only a couple minutes for them to take the samples.

Only discomfort (if you can call it that) was a tiny pin prick with the second needle that goes deep into the breast to numb the internal area and it was no more than the sting of a shot, lasted 3 secs, then faded.

Never felt the initial numbing shot (so they could make an incision) nor any of the 12 samples taken with the core needle. Only heard the sound.

The only thing NOW is waiting for the doctor to call with results and the nervousness beforehand of the unknown procedure.

Anonymous said...

This is awful: Unnecessary biopsies sometimes trigger dormant cancer.


Anonymous said...

Just had my annual mammogram on Christmas eve and had to go BACK for a “recall” appointment this morning. (I like to think of it as the annual "boob squash"). All they would tell me is that they wanted to take more pictures of my right breast. It was scary enough having to wait until today for the recall. I thought, oh my God they found something. Better start my “bucket list”.

This year, however, was different. This was the first nurse that ever mentioned caffeine to me as a cause for aggravating fibroid cysts. She showed me the digital photos so I could actually see the fibroid tissue in the breast. She also mentioned that “..doctors won’t tell you this but you really need to cut out the caffeine 2 days prior to your mammogram (that includes diet cola and chocolate) and if possible switch to de-caf altogether.
Especially true she said, "..if fibroid cysts run in your family". Well halleluiah. No one ever mentioned that to me. I had switched to de-caf last year but then started drinking regular again the last couple of months. This was the first time I had ever heard of a direct connection between caffeine drinking and fibroids. I have been using Lugol's Iodine as a dietary supplement (which BTW, seems to be helpful in treatments for breast cancer, you might want to read more about Lugol's)
I told the nurse that Fibroids were hereditary in my family and she suggested I start educating my teenage daughter NOW. Keep her away from those bad caffeine habits before she gets hooked.My daughter already likes to stop at Starbucks and Dunkin Donuts with her friends.
The nurse I spoke with today had a 5-cup a day habit and noticed breast tenderness and pain along with the fibroids showing up in her
mammograms. When she switched to decaf it all went away. Guess that’s as good a resolution as any for 2010! Thankfully it all turned out ok and they sent me on my merry way for another year. What a relief. I'm going to talk about this more with my friends because I do think women are anxious about recall appointments (I was) and it's important to know that just little tweaks in the diet can make a big difference.

Anonymous said...

I am going for my biopsy tomorrow and have to wait until January 18 for the results. In the meantime, my family doctor is bothering me about coming in for a Pap smear since my previous one was "inadequate". Great - let's add to the unbelievable stress level with another cancer scare since there are a high number of false positives for menopausal women. I asked about getting estrogen for a few weeks prior to getting the Pap redone, but she doesn't "believe" in hormones, even though that is the standard protocol. I refuse to go through this for a few months, since my stress level after the recall mammogram is through the roof. The sad thing is that I felt healthy and happy before I went for all of this "routine" testing.

Zoey said...

So I had the biopsy last week, and yes it was not comfortable at all. The biopsy, etc. wasn't bad, it was that freaking table with your boob hanging through that was uncomfortable. I have a bad neck so having to lay there for 1.5 hours was a killer to say the least. I could barely move my neck when I was done. My questions is this, they called to tell me it was benign, however, I got a call the next day saying that the radiologist wanted to do another mammogram in 6 weeks. They had done a mammogram right after the biopsy, so is this normal to do it again this soon???? I'm nervous all over again --- ugh!!!!