Psychologic stress, reduced NK cell activity, and cytokine dysregulation in women experiencing diagnostic breast biopsy

Abstract

The purpose of this study was to evaluate a woman's psychological and immunological response to breast biopsy before and after the procedure. Women were enrolled into the study when notified of the need for breast biopsy. Psychological and immunological assessments were made at enrollment, on the day of breast biopsy, as well as 1 month and 4 months after notification of biopsy results. Psychological assessments demonstrated that perceived stress, anxiety, and mood disturbance were heightened before biopsy and remained elevated after biopsy regardless of the diagnosis. Immunologically, the women exhibited reduced natural killer cell activity and INF gamma production before biopsy with reductions significant 1 month after the procedure. In contrast, IL-4, IL-6, and IL-10 production were increased before and after the procedure with most significant increases prior to the procedure and continuing 1 month after the procedure. These results demonstrate that undergoing biopsy of the breast for cancer diagnosis is an emotional experience, characterized by increased perceived stress, anxiety, and mood disturbance. This emotional distress is accompanied by reduced NK cell activity and cytokine dysregulation. The psychological and immunological impact of breast biopsy is not transient, but persists well beyond the actual experience of the biopsy procedure. Noteworthy is the observation that women with benign or malignant biopsy results experienced similar psycho-immune consequences. Hence, these observations are of relevance not only to women diagnosed with malignancy, who face the challenges of cancer treatment and adaptation to illness, but also to women with benign biopsy findings.

Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer

“…Anxiety, fear, depression and uncertainty are prevalent at diagnosis (Northouse, 1992;Spiegel, 1996Spiegel, , 1997Stark and House, 2000;Witek-Janusek, et al, 2007) and distress typically intensifies with treatment burden (Berger, 1998;Berger, et al, 2007;Maraste et al, 1992;Nail and Winningham, 1995;Schreier and Williams, 2004;Theobald, 2004). The emotional response to breast cancer is independent of disease stage, as women diagnosed with non-invasive breast cancers also experience powerful emotions (Witek-Janusek, et al, 2007;Northouse, 1992;Rakovitch, et al, 2003). The emotional impact of a cancer diagnosis and the rigors of cancer treatment adversely affect quality of life (QOL) and this may persist beyond treatment (Longman, et al, 1999).…”

“…Women who report greater subjective stress after breast cancer surgery, but prior to adjuvant therapy, have lower basal and interferon (IFN) augmented NK cell activity (NKCA) and reduced T cell proliferative response to mitogens (Andersen, et al, 1998(Andersen, et al, , 2004. We have previously shown that this stress-induced immune dysregulation begins early in the diagnostic phase, as women stressed by the experience of breast biopsy have lower production of IFN gamma but increased production of IL-4, IL-10 and IL-6, when compared to non-biopsied control women (Witek-Janusek et al, 2007). This increase in IL-4 and IL-10 is similar to results of other studies in non-cancer populations that demonstrated stress-associated shifts in Th1/Th2 cytokine balance toward a Th2 response (Maes, et al, 1999;Marshall, et al, 1998).…”

“…The immune dysregulation included an increase in production of IL-4 and IL-6 and reduced NKCA and IFN gamma production (Nagabhushan, et al, 2001;Witek-Janusek et al, 2007). The dysregulation in immune function was dissociated from treatment effects and was likely due to the psychosocial distress evoked by a diagnosis of cancer and its treatment.…”

Near-Field Radar Microwave Imaging as an Add-on Modality to Mammography

“…Before the possibility of breast cancer is ruled out, a patient who receives a positive result is recalled for further examination that usually includes ultrasound imaging, needle biopsy, and sometimes surgical biopsies. These biopsies, which some authors call "unnecessary" [23,24], as well as the prolonged uncertainty about ones' health status, can be accompanied by a psychological trauma similar to those who were diagnosed with cancer in their first 6 months with symptoms such as short-term anxiety, more frequent self-examinations, and a change in the patients' tendency to attend later mammography sessions [25][26][27][28]. It has also been reported that 27 and 33% of women gone under breast biopsy had reduced sexual sensitivity and pain in the breast.…”

“…It has also been reported that 27 and 33% of women gone under breast biopsy had reduced sexual sensitivity and pain in the breast. In addition, an increment in mood disturbances and reduction in natural killer cell activity and INF γ production was observed before and after biopsy [26,27]. Therefore, FP results can lead to serious consequences that need to be addressed.…”