Mental and Physical Stressors in the Diagnosis of Breast Cancer: An Analysis of Distress and Systemic Biomarkers in Patients Referred for Biopsy of a Suspected Breast Cancer Lesion.
Authors: Tannenbaum S. , Phoenix N. , Kamath J. , Cruess D. , Wilson L. , Bacarro N. , Phoenix K. , Claffey K. 
Published: December 2010

Abstract
Background: Women diagnosed and treated for breast cancer will experience significant symptom distress including, fatigue, depression, anxiety and alterations in sleep. Inflammatory cytokines have been implicated in the symptom distress experienced by these women. There is little research of symptom distress related to the experience and results of breast biopsy. The current study is a multidisciplinary analysis of distress and systemic biomarkers in patients referred for biopsy of a suspected breast cancer lesion.Methods: 42 of 100 planned patients have been prospectively studied with blood samples and behavioral assessments at two time points; when first referred to a breast surgeon for a suspect imaging or clinical exam and post biopsy after the results are known. Behavioral assessments include the Hospital Anxiety and Depression Scale (HADS), the Brief Fatigue Inventory (BFI), the Pittsburgh Sleep Quality Index (PSQI), the European Organization for Research and Treatment of Cancer Quality of Life (EORTC-QOL) and the PANAS questionnaire. Scores were determined for each patient and correlated using Pearson's analysis. Plasma samples were analyzed with XMap bead multiplex assays for VEGF, EGF, INFγ, TNF, IL-1Β, IL-2, IL-6, FGF-2. The mean ± standard deviation was calculated for each biomarker at each time point.Results: When looking at the entire population and their test performances pre- and post-biopsy, there were highly significant (p&lt;.01) correlations between scores for depression (HADS-D), fatigue (BFI) and quality of life (EORTC-QOL). Of 42 patients studied, 13 had a positive cancer diagnosis (31%). There were no significant differences noted in scores between the patients with a cancer (+) versus a benign (-) diagnosis, however trends were present. QOL scores declined in 9/13 (69%) (+) patients and 10/29 (34%) (-) patients while QOL scores improved in 1/13 (8%) (+) patients and 9/29 (31%) (-) patients. Anxiety mood disorder was present at baseline (HADS) in 3/9 (+) patients tested (34%) versus 4/23 (-) patients (17%). The average pre-biopsy scores for anxiety were higher for the (+) patient group, yet both patient groups had similarly reduced anxiety levels after diagnosis. 17% of (-) patients developed a significant anxiety mood disorder after diagnosis while none of those in the positive group did. Depression was less of a problem in both groups with little change in scores pre- and post-diagnosis. Mild fatigue (BFI)was noted in 69% of all patients (77% of those with + diagnosis) with little change after diagnosis. Serum biomarkers did not significantly correlate with cancer diagnosis. but IL-6 levels were inversely related to the fatigue symptom portion of ETORC.Conclusions: There is significant impact of a possible cancer diagnosis on a patients' sense of well being and functioning. Perceived risk may impact on this greatly and may be self imposed and/or a result of patient-healthcare system interaction. This will only increase as screening for breast cancer includes newer, more sensitive modalities for cancer detection that increase the detection of suspect lesions. Increasing awareness and interventions should be considered even when cancer is not diagnosed.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1070.