The agonizing wait for breast cancer biopsy results can be harmful to a woman's health. The results of a new study suggests not knowing a diagnosis can lead to stress that may have adverse effects on the immune system.Any of you who've awaited the results of high-stakes medical tests are probably thinking: Well, duh! The day I got my initial, troubling MRI results, I was in tears for much of the day before I even saw my doctor. I'm pretty sure my cortisol levels stayed sky-high for a several weeks, until I heard that I didn't have MS and that the radiologist who read the scans was probably mostly covering his ass.
More than 1.2 million breast biopsies are performed each year in the U.S. -- 80 percent result in non-cancerous findings. In this new study, researchers sought to establish a biochemical marker to assess the physical effects associated with the stress of extended waiting for a final diagnosis. They collected stress hormone [cortisol] samples from 126 women who had just undergone a large core biopsy. Four days later, the scientists learned the stress hormone levels of women with uncertain results were significantly different than women with benign results, but highly similar to women with malignant results.
(The original study is published in Radiology, March 2009, full reference below.)
So why is there any value in a study like this one? Because even though its findings are glaringly obvious, it points out that most of the women in the study had to wait at least five days for results. The study's authors, Elvira Lang et al., recommend in another well, duh! moment:
It is important to deliver histopathologic results in a timely fashion.Or to put it bluntly, doctors and hospitals need to organize anxiety-producing procedures with the patient's needs in mind, not the organization's. This would be worthwhile even if stress weren't a risk factor for (additional) illness.
(Source: Elvira V. Lang et al., "Large-Core Breast Biopsy: Abnormal Salivary Cortisol Profiles Associated with Uncertainty of Diagnosis," Radiology 2009;250:631-637.)
By the way, it's not just women who would benefit from faster, healthier, and more humane delivery of test results. Lang et al. cite a larger, better-powered study in which men who underwent prostate biopsy had the most abnormal cortisol levels two weeks after the biopsy, right before they got their results. Like breast biopsies, prostate biopsies are more painful than doctors will generally admit, or so I hear from people who've experienced one or the other procedure. A cancer diagnosis in either case often strikes at a person's identity and sexuality as well as raising fears of mortality. Lang et al. write (again in the full text version):
These authors reported that some of their patients described the waiting period as a nightmare.That earlier study was published in 1995, and yet people often still wait a week for test results. I'm hoping the new study might make a bigger splash, as breast cancer news tends to attract more media attention.
How long is the waiting period, exactly, before an obvious iatrogenic risk can be diagnosed and treated?