Waiting For Biopsy Results May Be Harmful to Your Health
< Feb. 25, 2009 > -- A Harvard research study found abnormal levels of a stress hormone in women waiting for breast biopsy results.
In the US, more than a million breast biopsies are performed each year, with 80 percent of them turning up benign (non-cancerous).
In the March issue of Radiology, a research study argues for faster relaying of results, because the overall health of women waiting for breast biopsy results can be negatively affected due to abnormal levels of a stress hormone called cortisol. These levels stem from anxiety or stress and can compromise future medical treatment if biopsy results come back malignant (cancerous). This theory has been intuitively obvious to women for centuries, now scientific evidence exists due to research studies.
"For a long time, there has been the recognition that women should find out sooner what they have, but there was just not much effort put into it," says Dr. Elvira V. Lang, an associate professor of radiology at Harvard Medical School in Boston and an author of the study. "When women just say they're stressed, there's a tendency to put it aside as psychological. But once you can show there can be adverse effects on the immune system and on what the next steps are, particularly in women who may be diagnosed and women who have future interactions with the healthcare system, then this gets a completely different light on it."
"The medical community isn't going to believe this until there's some biochemical data," she adds.
"These findings don't surprise me," says Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "It's very stressful, and we try to have biopsies that have as quick a turnaround as possible. We have emergency medical records so patients today are going to get a CAT scan, are going to get off the table, walk off the elevator and see me, and get their results immediately."
A Research Study Evaluating Cortisol Levels
Cortisol is a hormone produced by the adrenal gland and known as the "stress hormone." In challenging and/or uncomfortable situations, cortisol helps the body fight stress by adjusting and regulating blood pressure, blood sugar, and the response of the immune system. Imbalances of this hormone due to continuous stress can cause adverse effects - impairment to the immune system and wound healing.
Women, 18 to 86 years old, who were scheduled for a large-core breast biopsy were enrolled in the research study. Researchers obtained saliva samples from 126 participants. Cotton swabs were used to collect saliva samples on the day of the biopsy and four days following the scheduled procedure. The samples were tested to evaluate the cortisol levels of each participant.
Research subjects were informed of biopsy results - benign, malignant, or uncertain - within one to six days after their large-core breast biopsy. Sixteen subjects were diagnosed with breast cancer; 37 subjects were informed their biopsies were benign; and 73 subjects had biopsy results with an undetermined diagnosis that required further evaluation.
Researchers compared cortisol levels among three groups of research subjects:
The release of cortisol in the "uncertain group" was similar to the "known malignant group", but was significantly different when compared to women in the "known benign group."
"Normally, cortisol levels are high in the morning and get lower during the day, so what really counts is the slope over the daytime," Dr. Lang explains. "The cortisol mechanism is set up for responding to acute stress so we can adapt quickly, like fight or flight. That's a good thing. But if the system gets overstressed, then you don't react to quick things that happen in daily life in an appropriate fashion."
"It's not like this fine-tuned Swiss clock anymore," she adds.
If the mechanism that regulates the cortisol system is not working properly, everything from wound healing to blood sugar, blood pressure, and immune defense can be affected. "Particularly now, in these times of uncertainty, let's acknowledge that uncertainty can wreck your immune system," Dr. Lang says.
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