Stress and Breast Biopsies

Purpose: To determine whether uncertainty of the diagnosis after large-core breast biopsy (LCBB) adversely affects biochemical stress levels.

Results: Women learned their diagnosis on days 1–6 (mean, day 2.4) after LCBB

Conclusion: Uncertainty about the final diagnosis after LCBB is associated with substantial biochemical distress, which may have adverse effects on immune defense and wound healing. Results indicate the need for more rapid communication of biopsy results.

Large-Core Breast Biopsy: Abnormal Salivary Cortisol Profiles Associated with Uncertainty of Diagnosis [Radiology]

The science of the paper isn’t great and the conclusions made regarding wound healing with mildly elevated cortisol levels is conjectural at best, but papers like this don’t have to be great science. The point is that women experience a tremendous amount of emotional stress while waiting for breast biopsy results and we as physicians ought to do everything we can to get those results to them as soon as possible. For core or needle biospies, it ought not to take more than 24-48 hours. For lumpectomies or axillary dissections however, it could very well take several days but no woman should be waiting more than a week.

Waiting and Stress and Breast Biopsies [Buckeye Surgeon]

Cervical Cancer Biomarker

A simple test for a protein called P16INK4A provided a biomarker showing cell changes that indicated a woman likely has pre-cancerous lesions

“The marker shows there was some sort of disruption by the HPV virus,” Ronco said. “Only a small minority of women who have an HPV infection actually develop cancer. The challenge is to find out who are at higher risk of developing cancer.”

The Italian team collected cervical cell samples from women who had already tested positive for the HPV virus… Then they tested for P16INK4A protein in more than 1,100 of these women and found that it helped identified 88 percent of those who had the cancer-causing lesions with far fewer false positives. The protein is more active in cervical-cancer cells.

The refined test also identified 50 percent more of the dangerous lesions than pap smears and required fewer women to be referred for colposcopy

New cervical cancer test beats pap smear [Reuters]

How to Give Bad News (Randy Pausch)

The horrible exchange was surreal for me.  Yes, I felt stunned and bereft for myself and especially for Jai, who couldn’t stop crying.  But a strong part of me remained in Randy Scientist Mode, collecting facts and quizzing the doctor about options.  At the same time, there was another part of me that was utterly engaged in the theater of the moment.  I felt incredibly impressed – awed really – by the way Dr. Wolff was giving the news to Jai.  I thought to myself: “Look at how he’s doing this.  He’s obviously done this so many times before, and he’s good at it.  He’s carefully rehearsed, and yet everything is still so heartfelt and spontansous.”

I took note of how the doctor rocked back in his chair and closed his eyes before answering a question, almost as if that was helping him think harder.  I watched the doctor’s body posture, the way he sat next to Jai.  I found myself almost detached from it all, thinking: “He isn’t putting his arm around her shoulder.  I understand why.  That would be too presumptuous.  But he’s leaning in, his hand on her knee.  Boy, he’s good at this.”

I wished every medical student considering oncology could see what I was seeing.  I watched Dr. Wolff use semantics to phrase whatever he could in a positive light.  When we asked, “How long before I die?” he answered, “You probably have three to six months of good health.”  That reminded me of my time at Disney.  Ask Disney World workers: “What time does the park close?” They’re supposed to answer: “The park is open until 8 p.m.”

The Park Is Open Until 8 p.m. [The Last Lecture by Randy Pausch]

Correlate: Delivering Bad News & Crying

Correlate: How to Communicate with Cancer Patients

Correlate: Discussing End-of-Life Care

Pituitary Tumors

A thorough primer for pituitary tumors offered by the Mayo Clinic & geared for patients