Women's experience with breast biopsy

Are Diagnostic Delays Associated with Distress in Breast Cancer Patients?

Introduction

Receiving a new breast cancer diagnosis can cause anxiety and distress, which can lead to psychologic morbidity, decreased treatment adherence, and worse clinical outcomes. Understanding sources of distress is crucial in providing comprehensive care. This study aims to evaluate the relationship between delays in breast cancer diagnosis and patient-reported distress. Secondary outcomes include assessing patient characteristics associated with delay.

Methods

Newly diagnosed breast cancer patients who completed a distress screening tool at their initial evaluation at an academic institution between 2014 and 2019 were retrospectively evaluated. The tool captured distress levels in the emotional, social, health, and practical domains with scores of "high distress" defined by current clinical practice guidelines. Delay from mammogram to biopsy, whether diagnostic or screening mammogram, was defined as >30 days.

Result

745 newly diagnosed breast cancer patients met inclusion criteria. Median time from abnormal mammogram to core biopsy was 12 days, and 11% of patients experienced a delay in diagnosis. The non-delayed group had higher emotional (p = 0.04) and health (p = 0.03) distress than the delayed group. No statistically significant differences in social distress were found between groups. Additionally, patients with higher practical distress had longer time interval between mammogram and surgical intervention compared to those with lower practical distress. Older age, diagnoses of invasive lobular carcinoma or ductal carcinoma in situ, and clinical anatomic stages 0-I were associated with diagnostic delay.

Conclusion

Patients with higher emotional or health-related distress were more likely to have timely diagnoses of breast cancer, suggesting that patients with higher distress may seek healthcare interventions more promptly. Improved understanding of sources of distress will permit early intervention regarding the devastating impact of breast cancer diagnosis.

Core Needle Biopsy Guidance Based on Tissue Morphology Assessment with AI-OCT Imaging

This paper presents a combined optical imaging/artificial intelligence (OI/AI) technique for the real-time analysis of tissue morphology at the tip of the biopsy needle, prior to collecting a biopsy specimen. This is an important clinical problem as up to 40% of collected biopsy cores provide low diagnostic value due to high adipose or necrotic content. Micron-scale-resolution optical coherence tomography (OCT) images can be collected with a minimally invasive needle probe and automatically analyzed using a computer neural network (CNN)-based AI software. The results can be conveyed to the clinician in real time and used to select the biopsy location more adequately. This technology was evaluated on a rabbit model of cancer. OCT images were collected with a hand-held custom-made OCT probe. Annotated OCT images were used as ground truth for AI algorithm training. The overall performance of the AI model was very close to that of the humans performing the same classification tasks. Specifically, tissue segmentation was excellent (~99% accuracy) and provided segmentation that closely mimicked the ground truth provided by the human annotations, while over 84% correlation accuracy was obtained for tumor and non-tumor classification.

Post-enrichment circulating tumor cell detection and enumeration via deformability impedance cytometry

Circulating tumor cells (CTCs) in blood can provide valuable information when detecting, diagnosing, and monitoring cancer. This paper describes a system that consists of a constriction-based microfluidic sensor with embedded electrodes that can detect and enumerate cancer cells in blood. The biosensor measures impedance in terms of magnitude and phase at multiple frequencies as cells transit through the constriction channel. Cancer cells deform as they move through while blood cells remain intact, thus generating differential impedance profiles that can be used for detecting and counting CTCs. Two versions of this device are reported, one where the electrodes are embedded into the disposable microfluidic channel, and the other in which the disposable chip is externally fixed to a reusable substrate housing the electrodes. Both configurations were tested by spiking breast or prostate cancer cells into murine blood, and both detected all tumor cells passing through the narrow channels while being able to differentiate between the two cell lines. The chip in its current format has a throughput of 1 μL/min. While the throughput is scalable by integrating more constriction channels in parallel, the presented assay is intended for post-enrichment label-free enumeration and characterization of CTCs.

Developing a Decision-Aid Website for Breast Cancer Surgery: An Action Research Approach

Background

Patients with early-stage breast cancer have numerous options when choosing the type of breast surgery method to be applied. Each of these options lead to a similar long-term survival rate, but result in significant differences in appearance, function, cost, recurrence rate, and various other relevant considerations. However, the time available for detailed communication with each patient is often limited in clinics, which puts these women under great psychological stress and can hinder their surgery-related decision making.

Objective

The objective of this study was to develop a multipurpose surgery decision-making website providing medical information, psychological support, and decision-related simulation for women during breast cancer surgery-related decision making.

Methods

Using the 4 steps of action research, which involve multigroup teamwork via regular team meetings, the following were performed: (1) Planning: searching, analyzing, and evaluating health websites to consensually decide the major infrastructure; (2) Action: work was performed simultaneously in 4 groups, which consisted of medical information collection and editing, patient interviews and data extraction, webpage content design, and programming to create or host the website; (3) Evaluation: the website was tested by clinical experts and focus groups of former breast cancer patients to assess its effectiveness and pinpoint appropriate improvements; and (4) Reflection: constant dialogue was conducted between the various participants at each step, which was used as the foundation and motivation of next plan-action-evaluation-reflection circle.

Results

Using the action research approach, we completed the development of our website, which includes the following: (1) “Woman’s Voice”—an animated comic depicting the story of a female breast cancer patient with interspersed questions for the users that will help them better empathize with the experience; (2) “Cancer Information Treasure House”—providing breast cancer surgery-related information through text, tables, pictures and a presentation video; (3) “Decision-making Simulator”—helping patients think through and check the pros and cons of the different surgical options via visual-based interactions including “Stairs Climbing” and “Fruit of Hope”; and (4) “Recommended Links”—providing reliable websites for further reference. Additionally, we have further improved the website based on the feedback received from postsurgery breast cancer patients and clinicians. We hope to continue improving to better meet both the patients’ and health providers’ needs and become a practical decision-making aid for patients undergoing breast cancer surgery.

Conclusions

We have created the first breast cancer surgery decision-making assistance tool in Taiwan using a “Web-based” and multifunctional website design. This site aims to provide health care knowledge, psychological healing, and emotional support functions, as well as decision-making capability enhancement simulations. We look forward to assisting breast cancer patients in their decision-making process and expect our website to increase patient’s autonomy and improve their communication with clinicians.

How Many of the Biopsy Decisions Taken at Inexperienced Breast Radiology Units Were Correct?

OBJECTIVE

In this study, we aimed to determine the need for biopsy in patients referred from other clinics for the performance of biopsy with the suspicion of breast cancer.

MATERIALS AND METHODS

112 patients were included in the study. It was decided that their biopsies be performed following examinations in other clinics and they presented to the breast radiology unit of our hospital for a second opinion. The demographic characteristics, diagnostic studies completed in the other centers, properties of lesions, decision made as a result of examinations and BI-RADS (Breast Imaging Reporting and Data Systems) categorizations were recorded on the registration forms of the study patients. In addition, the quality of examinations, reasons of repeat tests, additional tests features and the last decision of our clinic were documented. The obtained data were analyzed in terms of re-examination, additional tests and change in the biopsy decision. Changes in the biopsy decisions for patients were specifically inquired.

RESULTS

The biopsy decisions were cancelled in our breast radiology unit for 63 out of 112 patients (56.3%) whose biopsy decisions were made at an external institute. For 42 patients, examinations made by the other clinics were deemed adequate, yet there was no need for biopsy in 22 of them. The biopsy decisions were cancelled for 27 out of 47 patients (57.4%) with repeat examination and 18 out of 28 patients (64.3%) with additional tests because of the insufficient test quality.

CONCLUSION

Incorrect, inadequate breast screening and false positivity were higher at inexperienced institutes.

Diagnostic invasiveness and psychosocial consequences of false-positive mammography

PURPOSE

We undertook a study to assess whether women with false-positive mammography have worse psychosocial consequences if managed with a workup that involves a biopsy (invasive group) than if managed with only additional imaging (noninvasive group).

METHODS

We performed subgroup analysis of a cohort study of 454 women with abnormal screening mammography and 908 matched control women with normal results. Using a condition-specific questionnaire (Consequences of Screening in Breast Cancer), we assessed 12 psychosocial consequences at 5 time points (0, 1, 6, 18, and 36 months after final diagnosis) and compared the 2 groups of women with false-positives (invasive and noninvasive management groups).

RESULTS

Among the 252 women with false-positive mammography eligible for this study, psychosocial consequences were similar for those managed invasively and those managed noninvasively during the 36 months of follow-up. In 60 comparisons (12 scales and 5 time points), differences between the groups were never statistically significant (P <.01) and the point estimates for the differences were always close to zero. The psychosocial consequences of women with false-positive results, regardless of management, fell between those of women with normal mammography and those of women determined to have breast cancer.

CONCLUSIONS

We found no evidence that use of more invasive diagnostics was associated with worse psychosocial consequences. It is therefore reasonable to pool subgroups of women with false-positives in a single analysis. The invasiveness of subsequent diagnostic procedures does not help to identify women at higher risk for adverse psychosocial consequences of false-positive mammography.

Clinical, demographic, and situational factors linked to distress associated with benign breast biopsy

Benign breast biopsy (BBB) can be distressing for many women. Few studies have examined specific aspects of the BBB more or less distressing or risk factors for distress. Women (N = 51) who had a recent BBB reported the magnitude of distress associated with specific aspects of their experience. Clinical and demographic variables were also examined as risk factors for distress. All women reported some distress associated with the BBB with one third reporting their experience was "very stressful." Generally, biopsy-specific events were more distressing than follow-up mammography. Distress risk factors included younger age, less education, nonsurgical biopsy, and no family history of breast cancer. Clinical efforts to better manage biopsy-related distress are warranted. The authors identified clinical and demographic risk factors that furnish a simple, efficient, and potentially cost-effective means of stratifying risk for distress in the breast biopsy setting.

Effect of supportive care on the anxiety of women with suspected breast cancer

AIM

This paper is a report of a study of the effect of supportive care on anxiety levels of women with suspected breast cancer during the diagnostic period.

BACKGROUND

Informational and psychosocial support has been shown to improve care outcomes for women with breast cancer. However, little is known about the effect of supportive care on women's psychological status during the breast cancer diagnostic period.

METHODS

For this longitudinal quasi-experimental study, 122 participants were recruited from a large teaching hospital in Taiwan. The experimental group (n = 62) received a supportive care programme that included health education pamphlets about breast cancer diagnosis and treatment, three face-to-face sessions of informational and emotional support, and two follow-up telephone consultations. The control group (n = 60) received routine care. Data were collected from October 2006 to April 2007 using the State-Trait Anxiety Inventory at baseline (notification of need for breast biopsy), before biopsy, and after receiving biopsy result (diagnosis).

FINDINGS

After adjusting for covariance of breast discomfort, regular breast self-examination, and biopsy result, the anxiety levels of women receiving supportive care were significantly lower before biopsy (P = 0.017) and after diagnosis (P = 0.001) than those of women receiving routine care.

CONCLUSION

Supportive care that incorporates informational and emotional support and follow-up telephone consultations can decrease anxiety levels of women with suspected breast cancer. These findings can serve as a reference for clinical nursing staff to improve care quality during the breast cancer diagnostic period by providing women with individualized and culturally sensitive care.

Feasibility of family member presence in the OR during breast biopsy procedures

Family-centered care is an accepted and promoted philosophy within the health care community. Perioperative nurses are empowered to support change in the health care arena and to examine and institute policies that affect patient care. This study examined the feasibility of family presence in the OR during breast biopsy procedures performed with local anesthesia, by ascertaining perioperative nurses' attitudes toward the concept. Family presence in the OR during breast biopsy procedures is considered a novel initiative. The results of this study indicate that the feasibility of instituting this intervention would be challenged by system barriers.

Healthcare and support needs of women with suspected breast cancer

AIM

This paper is a report of a study to investigate changes in the healthcare and support needs during the diagnostic period, and factors that affect these needs in women with suspected breast cancer.

BACKGROUND

Although the needs of women with breast cancer are well recognized, few studies have examined the needs of women with suspected breast cancer during the diagnostic period.

METHOD

This longitudinal study used an investigator-developed, self-administered questionnaire to collect data from 127 women in Taiwan on three occasions: notification of need for breast biopsy, before biopsy and after diagnosis. The data were collected from November 2004 to April 2005.

FINDINGS

Participants had high need levels before and after diagnosis, with their top needs in the domains of healthcare services for diagnosis, follow-up and consultation, and information about the disease. They needed disease- and treatment-related information more than emotional support. Need levels were higher (P < 0.01) before diagnosis than after, highest before biopsy, and lowest after diagnosis. Furthermore, needs were higher (P < 0.01) before than after diagnosis for diagnostic services, disease information, and involvement of family and friends. Higher needs were found in married women with more education and no history of benign tumours. Need level did not differ statistically significantly by age, religious status, degree of social support, family history and breast symptoms.

CONCLUSION

Need levels of women with suspected breast cancer vary during the diagnostic period, are highest before breast biopsy, and related to personal characteristics and cultural context. Therefore, during this period, nursing staff should provide patients and families with culturally sensitive, individualized, supportive care.

Qualitative study of how women define and use information about breast symptoms and diagnostic tests

Unstructured interviews were conducted with 14 women with recent experience of diagnostic testing to explore the definition and role of information in women's experiences of undergoing diagnostic breast tests. Analysis showed that women see information as more than what they are told by healthcare professionals. Information also comes from significant others, administration and reception staff, media, comparison with previous breast symptoms, silences, gestures and behavior of healthcare professionals and significant others, and the number of tests they undergo. Information is about more than understanding. It can provide support and control, reduce anxiety, facilitate question asking and promote women's trust and confidence in themselves and their healthcare professionals. Healthcare professionals need to be aware that women define information more broadly than what they are told, and of the importance women attach to this other information. They also need to be aware that information serves more purposes than helping women understand the diagnostic testing process and their result.