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Older Women’s Experience with a Benign Breast Biopsy—A Mixed Methods Study

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Journal of General Internal Medicine Aims and scope Submit manuscript

A Capsule Commentary to this article was published on 19 September 2014

ABSTRACT

BACKGROUND

Little is known about older women’s experience with a benign breast biopsy.

OBJECTIVES

To examine the psychological impact and experience of women ≥ 65 years of age with a benign breast biopsy.

DESIGN

Prospective cohort study using quantitative and qualitative methods.

SETTING

Three Boston-based breast imaging centers.

PARTICIPANTS

Ninety-four English-speaking women ≥ 65 years without dementia referred for breast biopsy as a result of an abnormal mammogram, not aware of their biopsy results at baseline, and with a subsequent negative biopsy.

MEASUREMENTS

We interviewed women at the time of breast biopsy (before women knew their results) and 6 months post-biopsy. At both interviews, participants completed the validated negative psychological consequences of screening mammography questionnaire (PCQ, scores range from 0 to 36 [high distress], PCQ ≥ 1 suggests a psychological consequence, PCQs <1 are reported at time of screening) and women responded to open-ended questions about their experience. At follow-up, participants described the quality of information received after their benign breast biopsy. We used a linear mixed effects model to examine if PCQs declined over time. We also reviewed participants’ open-ended comments for themes.

RESULTS

Overall, 88 % (83/94) of participants were non-Hispanic white and 33 % (31/94) had a high-school degree or less. At biopsy, 76 % (71/94) reported negative psychological consequences from their biopsy compared to 39 % (37/94) at follow-up (p < 0.01). In open-ended comments, participants noted the anxiety (29 %, 27/94) and discomfort (28 %, 26/94) experienced at biopsy (especially from positioning on the biopsy table). Participants requested more information to prepare for a biopsy and to interpret their negative results. Forty-four percent (39/89) reported at least a little anxiety about future mammograms.

CONCLUSIONS

The high psychological burden of a benign breast biopsy among older women significantly diminishes with time but does not completely resolve. To reduce this burden, older women need more information about undergoing a breast biopsy.

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REFERENCES

  1. Gotzsche PC, Jorgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2013;6, CD001877.

    PubMed  Google Scholar 

  2. Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer. 2013;108:2205–2240.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Nelson HD, Zakher B, Cantor A, Fu R, Griffin J, O’Meara ES, Buist DS, Kerlikowske K, van Ravesteyn NT, Trentham-Dietz A, Mandelblatt JS, Miglioretti DL. Risk factors for breast cancer for women aged 40 to 49 years: a systematic review and meta-analysis. Ann Intern Med. 2012;156:635–648.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Lee SJ, Boscardin WJ, Stijacic-Cenzer I, Conell-Price J, O’Brien S, Walter LC. Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. BMJ. 2013;346:e8441.

    Article  PubMed  Google Scholar 

  5. Schonberg MA, Breslau ES, McCarthy EP. Targeting of mammography screening according to life expectancy in women aged 75 and older. J Am Geriatr Soc. 2013;61:388–395.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Schonberg MA, Leveille SG, Marcantonio ER. Preventive health care among older women: missed opportunities and poor targeting. Am J Med. 2008;121:974–981.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Schonberg MA, Silliman RA, Marcantonio ER. Weighing the benefits and burdens of mammography screening among women age 80 years or older. J Clin Oncol. 2009;27:1774–1780.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Welch HG, Fisher ES. Diagnostic testing following screening mammography in the elderly. J Natl Cancer Inst. 1998;90:1389–1392.

    Article  CAS  PubMed  Google Scholar 

  9. Brett J, Bankhead C, Henderson B, Watson E, Austoker J. The psychological impact of mammographic screening: a systematic review. Psycho Oncol. 2005;14:917–938.

    Article  CAS  Google Scholar 

  10. Heckman BD, Fisher EB, Monsees B, Merbaum M, Ristvedt S, Bishop C. Coping and anxiety in women recalled for additional diagnostic procedures following an abnormal screening mammogram. Health Psychol. 2004;23:42–48.

    Article  PubMed  Google Scholar 

  11. Liao MN, Chen MF, Chen SC, Chen PL. Healthcare and support needs of women with suspected breast cancer. J Adv Nurs. 2007;60:289–298.

    PubMed  Google Scholar 

  12. Lindfors KK, O’Connor J, Acredolo CR, Liston SE. Short-interval follow-up mammography versus immediate core biopsy of benign breast lesions: assessment of patient stress. AJR Am J Roentgenol. 1998;171:55–58.

    Article  CAS  PubMed  Google Scholar 

  13. Novy DM, Price M, Huynh PT, Schuetz A. Percutaneous core biopsy of the breast: correlates of anxiety. Acad Radiol. 2001;8:467–472.

    Article  CAS  PubMed  Google Scholar 

  14. Poole K. The emergence of the ‘waiting game’: a critical examination of the psychosocial issues in diagnosing breast cancer. J Adv Nurs. 1997;25:273–281.

    Article  CAS  PubMed  Google Scholar 

  15. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–714.

    Article  CAS  PubMed  Google Scholar 

  16. Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. External validation of an index to predict up to 9-year mortality of community-dwelling adults aged 65 and older. J Am Geriatr Soc. 2011;59:1444–1451.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Cockburn J, De Luise T, Hurley S, Clover K. Development and validation of the PCQ: a questionnaire to measure the psychological consequences of screening mammography. Soc Sci Med. 1992;34:1129–1134.

    Article  CAS  PubMed  Google Scholar 

  18. Pineault P. Breast cancer screening: women’s experiences of waiting for further testing. Oncol Nurs Forum. 2007;34:847–853.

    Article  PubMed  Google Scholar 

  19. Brett J, Austoker J. Women who are recalled for further investigation for breast screening: psychological consequences 3 years after recall and factors affecting re-attendance. J Public Health Med. 2001;23:292–300.

    Article  CAS  PubMed  Google Scholar 

  20. Lerman C, Daly M, Sands C, Balshem A, Lustbader E, Heggan T, Goldstein L, James J, Engstrom P. Mammography adherence and psychological distress among women at risk for breast cancer. J Natl Cancer Inst. 1993;85:1074–1080.

    Article  CAS  PubMed  Google Scholar 

  21. Lerman C, Trock B, Rimer BK, Boyce A, Jepson C, Engstrom PF. Psychological and behavioral implications of abnormal mammograms. Ann Intern Med. 1991;114:657–661.

    Article  CAS  PubMed  Google Scholar 

  22. Ware J Jr, Kosinski M, Keller SD. A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233.

    Article  PubMed  Google Scholar 

  23. Rehnberg G, Absetz P, Aro AR. Women’s satisfaction with information at breast biopsy in breast cancer screening. Patient Educ Couns. 2001;42:1–8.

    Article  CAS  PubMed  Google Scholar 

  24. Drageset S, Lindstrom TC. Coping with a possible breast cancer diagnosis: demographic factors and social support. J Adv Nurs. 2005;51:217–226.

    Article  PubMed  Google Scholar 

  25. Steffens RF, Wright HR, Hester MY, Andrykowski MA. Clinical, demographic, and situational factors linked to distress associated with benign breast biopsy. J Psychosoc Oncol. 2011;29:35–50.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Strauss A, Corbin J. Basics of qualitative research: grounded theory-procedures and techniques. Newbury Park: Sage Publication; 1990.

    Google Scholar 

  27. Crabtree F, Miller WL, eds. Doing qualitative research. Newbury Park, CA: Sage Publications; 1992.

    Google Scholar 

  28. Chen CC, David A, Thompson K, Smith C, Lea S, Fahy T. Coping strategies and psychiatric morbidity in women attending breast assessment clinics. J Psychosom Res. 1996;40:265–270.

    Article  CAS  PubMed  Google Scholar 

  29. Lebel S, Jakubovits G, Rosberger Z, Loiselle C, Seguin C, Cornaz C, Ingram J, August L, Lisbona A. Waiting for a breast biopsy. Psychosocial consequences and coping strategies. J Psychosom Res. 2003;55:437–443.

    Article  PubMed  Google Scholar 

  30. Nosarti C, Roberts JV, Crayford T, McKenzie K, David AS. Early psychological adjustment in breast cancer patients: a prospective study. J Psychosom Res. 2002;53:1123–1130.

    Article  PubMed  Google Scholar 

  31. Schnur JB, Montgomery GH, Hallquist MN, Goldfarb AB, Silverstein JH, Weltz CR, Kowalski AV, Bovbjerg DH. Anticipatory psychological distress in women scheduled for diagnostic and curative breast cancer surgery. Int J Behav Med. 2008;15:21–28.

    Article  PubMed  Google Scholar 

  32. Seckel MM, Birney MH. Social support, stress, and age in women undergoing breast biopsies. Clin Nurs Spec. 1996;10:137–143.

    Article  CAS  Google Scholar 

  33. Deane KA, Degner LF. Determining the information needs of women after breast biopsy procedures. AORN J. 1997;65(767–72):75–76.

    Google Scholar 

  34. Montgomery M, McCrone SH. Psychological distress associated with the diagnostic phase for suspected breast cancer: systematic review. J Adv Nurs. 2010;66:2372–2390.

    Article  PubMed  Google Scholar 

  35. Olsson P, Armelius K, Nordahl G, Lenner P, Westman G. Women with false positive screening mammograms: how do they cope? J Med Screen. 1999;6:89–93.

    Article  CAS  PubMed  Google Scholar 

  36. Di Maio M, Perrone F. Quality of life in elderly patients with cancer. Health Qual Life Outcomes. 2003;1:44.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Ganz PA, Guadagnoli E, Landrum MB, Lash TL, Rakowski W, Silliman RA. Breast cancer in older women: quality of life and psychosocial adjustment in the 15 months after diagnosis. J Clin Oncol. 2003;21:4027–4033.

    Article  PubMed  Google Scholar 

  38. Sammarco A. Quality of life of breast cancer survivors: a comparative study of age cohorts. Cancer Nurs. 2009;32:347–356. quiz 57–8.

    Article  PubMed  Google Scholar 

  39. Mandelblatt JS, Edge SB, Meropol NJ, Senie R, Tsangaris T, Grey L, Peterson BM Jr, Hwang YT, Kerner J, Weeks J. Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care. J Clin Oncol. 2003;21:855–863.

    Article  PubMed  Google Scholar 

  40. Silliman RA, Dukes KA, Sullivan LM, Kaplan SH. Breast cancer care in older women: sources of information, social support, and emotional health outcomes. Cancer. 1998;83:706–711.

    Article  CAS  PubMed  Google Scholar 

  41. Mor V, Allen S, Malin M. The psychosocial impact of cancer on older versus younger patients and their families. Cancer. 1994;74:2118–2127.

    Article  CAS  PubMed  Google Scholar 

  42. Ballantyne PJ. Social context and outcomes for the ageing breast cancer patient: considerations for clinical practitioners. J Clin Nurs. 2004;13:11–21.

    Article  PubMed  Google Scholar 

  43. Deimling GT, Arendt JA, Kypriotakis G, Bowman KF. Functioning of older, long-term cancer survivors: the role of cancer and comorbidities. J Am Geriatr Soc. 2009;57(Suppl 2):S289–S292.

    Article  PubMed  Google Scholar 

  44. Neale AV, Tilley BC, Vernon SW. Marital status, delay in seeking treatment and survival from breast cancer. Soc Sci Med. 1986;23:305–312.

    Article  CAS  PubMed  Google Scholar 

  45. Ong G, Austoker J, Brett J. Breast screening: adverse psychological consequences one month after placing women on early recall because of a diagnostic uncertainty. A multicentre study. J Med Screen. 1997;4:158–168.

    CAS  PubMed  Google Scholar 

  46. Degnim AC, Visscher DW, Berman HK, et al. Stratification of breast cancer risk in women with atypia: a Mayo cohort study. J Clin Oncol. 2007;25(19):2671–2677.

    Article  PubMed  Google Scholar 

  47. Chun J, Pocock B, Joseph KA, El-Tamer M, Klein L, Schnabel F. Breast cancer risk factors in younger and older women. Ann Surg Oncol. 2009;16(1):96–99.

    Article  PubMed  Google Scholar 

  48. Schonberg MA, Ramanan RA, McCarthy EP, Marcantonio ER. Decision making and counseling around mammography screening for women aged 80 or older. J Gen Intern Med. 2006;21(9):979–985.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Tosteson AN, Fryback DG, Hammond CS. Consequences of false-positive screening mammograms. JAMA Intern Med. 2014;174(6):954–961.

    Article  PubMed  Google Scholar 

  50. Barton MB, Moore S, Polk S, Shtatland E, Elmore JG, Fletcher SW. Increased patient concern after false-positive mammograms: clinician documentation and subsequent ambulatory visits. J Gen Intern Med. 2001;16:150–156.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Acknowledgements

We are grateful to Rossana Valencia, MPH, Christine Gordon, MPH, and Maria Cecilia Griggs, RN, MPH, for their work recruiting patients to this study. We are also grateful to Elena Morozov at Beth Israel Deaconess Medical Center, and Julie Ferragamo and Jane Pietrantonio at Brigham and Women’s Hospital for helping us to identify patients for this study. Written permission has been obtained from all persons named in this acknowledgment. Dr. Schonberg had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Mara Schonberg was supported by a Paul B. Beeson Career Development Award in Aging supported by the National Institute on Aging K23 [K23AG028584], the John A. Hartford Foundation, the Atlantic Philanthropies, the Starr Foundation, and the American Federation for Aging Research. Dr. Ngo received support from Harvard Catalyst, the Harvard Clinical and Translational Science Center (NIH Award #UL1 RR 025758 and financial contributions from Harvard University and its affiliated academic health care centers). Dr. Marcantonio was supported by a Midcareer Investigator Award in Patient-Oriented Research from the National Institute on Aging (K24 AG035075). The sponsors had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Presentations

This work was presented in part at the Presidential poster session of the 2014 annual meeting of the American Geriatrics Society, 15 May 2014. This work was also presented at the 2014 annual meeting of the New England Region of the Society of General Internal Medicine, 7 March 2014.

Conflict of Interest

Dr. Fein-Zachary worked as a consultant for Siemens Medical Solutions USA, Inc., in 2014. All other authors declare that they do not have a conflict of interest.

Financial Disclosure Information

This research was supported by a Paul B. Beeson Career Development Award in Aging supported by the National Institute on Aging K23 [K23AG028584], the John A. Hartford Foundation, the Atlantic Philanthropies, the Starr Foundation, and the American Federation for Aging Research. Dr. Marcantonio was supported by a Midcareer Investigator Award in Patient-Oriented Research from the National Institute on Aging (K24 AG035075).

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Authors and Affiliations

  1. Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Mara A. Schonberg MD, MPH, Long H. Ngo PhD, Jessica Donato MD & Edward R. Marcantonio MD, SM

  2. Geriatrics Section, Boston University Schools of Medicine and Public Health, Boston University Medical Center, Boston, MA, USA

    Rebecca A. Silliman MD, PhD

  3. Breast Imaging, Department of Radiology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA

    Robyn L. Birdwell MD

  4. Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    Valerie Fein-Zachary MD

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  1. Mara A. Schonberg MD, MPH
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  2. Rebecca A. Silliman MD, PhD
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  3. Long H. Ngo PhD
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  5. Valerie Fein-Zachary MD
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  6. Jessica Donato MD
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  7. Edward R. Marcantonio MD, SM
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Corresponding author

Correspondence to Mara A. Schonberg MD, MPH.

Appendix

Appendix

Table 5 Perceptions of Information Received After a Breast Biopsy by Age
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Schonberg, M.A., Silliman, R.A., Ngo, L.H. et al. Older Women’s Experience with a Benign Breast Biopsy—A Mixed Methods Study. J GEN INTERN MED 29, 1631–1640 (2014). https://doi.org/10.1007/s11606-014-2981-z

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