Older Women’s Experience with a Benign Breast Biopsy—A Mixed Methods Study

Schonberg, Mara A.; Silliman, Rebecca A.; Ngo, Long; Birdwell, Robyn L.; Fein‐Zachary, Valerie; Donato, Jessica; Marcantonio, Edward R.

doi:10.1007/s11606-014-2981-z

Cited by 23 publications

(13 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…22,24,25 Meanwhile, of 94 women aged 65 and older who experienced a breast biopsy that was ultimately read as benign, 76% (71/94) reported a negative psychological consequence (e.g., lack of sleep) at the time of breast biopsy, and 39% (37/94) reported that they were still experiencing a negative psychological consequence 6 months later. 26 A stereotactic breast biopsy may be particularly burdensome to older women, especially those with osteoarthritis, because of the amount of time required and positioning on the biopsy table. 26 Overdiagnosis is a particularly troubling harm of cancer screening because it leads to diagnosis and treatment of tumors that otherwise would never have caused problems in an older woman's lifetime.…”

Section: Benefits and Risks Of Mammography In Older Womenmentioning

confidence: 99%

Decision‐Making Regarding Mammography Screening for Older Women

Schonberg

2016

J American Geriatrics Society

Self Cite

View full text Add to dashboard Cite

The population is aging and breast cancer incidence increases with age peaking between ages 75–79. However, it is not known if mammography screening helps women ≥75 years live longer since none of these women were included in randomized controlled trials evaluating mammography screening. Guidelines recommend that older women with <10-year life expectancy not be screened since it takes approximately 10 years before a screen-detected breast cancer may impact an older woman’s survival. For women ≥75 years with ≥10 year life expectancy, guidelines recommend that clinicians discuss the benefits and risks of screening with older women to help these women elicit their values and preferences. It is estimated that 2 out of 1,000 women that continue to be screened biennially from ages 70–79 may avoid breast cancer death. However, 12–27% of these women will experience a false positive test and 10–20% of women that experience a false positive test undergo a benign breast biopsy. In addition, approximately 30% of screen-detected cancers would not otherwise have shown up in an older woman’s lifetime. Yet nearly all older women undergo treatment for these breast cancers and the risks of treatment increase with age. To inform decision-making, tools are available to estimate patient life expectancy and to educate older women about the benefits and harms of mammography screening. In addition, guides are available to help clinicians discuss stopping screening with older women with <10 year life expectancy. Ideally, screening decisions would consider an older woman’s life expectancy, breast cancer risk, and her values and preferences.

show abstract

Section: Benefits and Risks Of Mammography In Older Womenmentioning

confidence: 99%

Decision‐Making Regarding Mammography Screening for Older Women

Schonberg

2016

J American Geriatrics Society

Self Cite

View full text Add to dashboard Cite

show abstract

“…We found negative psychological consequences of the procedure, similar to a prior study using the PCQ to assess the consequences of undergoing breast biopsy for the detection of breast cancer. 12 Most of the participants experienced at least some pre-procedural anxiety related to recurrence of disease, which for some was quite substantial, indicating that psychological distress is an important part of patients’ experience prior to an invasive procedure. Participants suggested that their pre-procedural anxiety was due to the potential for detecting disease, rather than having the procedure itself; this is consistent with a study of patients’ anxiety prior to rigid cystoscopy using a visual analogue scale.…”

Section: Discussionmentioning

confidence: 97%

The Burden of Cystoscopic Bladder Cancer Surveillance: Anxiety, Discomfort, and Patient Preferences for Decision Making

Koo

Zubkoff

Sirovich

et al. 2017

Urology

View full text Add to dashboard Cite

Objective To examine discomfort, anxiety, and preferences for decision-making in patients undergoing surveillance cystoscopy for non-muscle-invasive bladder cancer (NMIBC). Methods Veterans with a prior diagnosis of NMIBC completed validated survey instruments assessing procedural discomfort, worry, and satisfaction, and were invited to participate in semi-structured focus groups about their experience and desire to be involved in surveillance decision-making. Focus group transcripts were analyzed qualitatively, using (1) systematic iterative coding, (2) triangulation involving multiple perspectives from urologists and an implementation scientist, and (3) searching and accounting for disconfirming evidence. Results Twelve patients participated in three focus groups. Median number of lifetime cystoscopy procedures was 6.5 (interquartile range 4–10). Based on survey responses, two-thirds of participants (64%) experienced some degree of procedural discomfort or worry, and all participants reported improvement in at least two dimensions of overall well-being following cystoscopy. Qualitative analysis of the focus groups indicated that participants experience pre-procedural anxiety and worry about their disease. While many participants did not perceive themselves as having a defined role in decision-making surrounding their surveillance care, their preferences to be involved in decision-making varied widely, ranging from acceptance of the physician’s recommendation, to uncertainty, to dissatisfaction with not being involved more in determining the intensity of surveillance care. Conclusions Many NMIBC patients experience discomfort, anxiety, and worry related to disease progression and not only cystoscopy. While some patients are content to defer surveillance decisions to their physicians, others prefer to be more involved. Future work should focus on defining patient-centered approaches to surveillance decision-making.

show abstract

“…75, 79, 80 While follow-up tests such as diagnostic mammograms and breast ultrasounds are generally low-risk procedures, approximately 10–20% of older women that experience a false positive mammogram undergo a benign breast biopsy 75, 79, 80 which can be stressful and uncomfortable for older women. 81 Overdiagnosis is a particularly concerning harm since the risks of breast cancer treatment increase as women age. 82 Quantifying overdiagnosis, however, remains challenging and estimates vary from 0 to 50% of screen-detected breast cancers; however most estimates tend to average around 30%.…”

Section: Breast Cancermentioning

confidence: 99%

Cancer Screening in the Elderly

Kotwal¹,

Schonberg²

2017

Cancer J

Self Cite

View full text Add to dashboard Cite

There is relatively limited data on outcomes of screening older adults for cancer; therefore, the decision to screen older adults requires balancing the potential harms of screening and follow-up diagnostic tests with the possibility of benefit. Harms of screening can be amplified in older and frail adults, and include discomfort from undergoing the test itself, anxiety, potential complications from diagnostic procedures resulting from a false-positive test, false reassurance from a false-negative test, and overdiagnosis of tumors that are of no threat and may result in overtreatment. In this paper, we review the evidence and guidelines on breast, colorectal, lung and prostate cancer as applied to older adults. We also provide a general framework for approaching cancer screening in older adults by incorporating evidence-based guidelines, patient preferences, and patient life expectancy estimates into shared screening decisions.

show abstract

Older Women’s Experience with a Benign Breast Biopsy—A Mixed Methods Study

Abstract: The high psychological burden of a benign breast biopsy among older women significantly diminishes with time but does not completely resolve. To reduce this burden, older women need more information about undergoing a breast biopsy.

Cited by 23 publications

References 51 publications

Decision‐Making Regarding Mammography Screening for Older Women

Decision‐Making Regarding Mammography Screening for Older Women

The Burden of Cystoscopic Bladder Cancer Surveillance: Anxiety, Discomfort, and Patient Preferences for Decision Making

Cancer Screening in the Elderly

Contact Info

Product

Resources

About